The Context of HIV Risk Among Drug Users and Their Sexual Partners

locale. More discussion of geographic variations in HIV/AIDS
epidemiology appears in this chapter under the section on technical
issues. For now, attention is called to such place-related concerns as
availability of injection drugs and of free sterilized needles and proximity
to crack houses, abandoned housing, and red light districts when
considering the role of exosystem variables in HIV/AIDS risk-related
behavior.
The next level addressed in the ecological model is the microsystem.
This level subsumes the life settings in which the individual interacts with
others. Research on peer networks and on sibling sets falls into this
domain (Brunswick et al., forthcoming). The difference between
perceived and so-called real measures at this level—between what a
respondent reports about network characteristics and behavior (perceived)
and actual observations or interviews with the network (real)—is a
particularly cogent issue. Both of these are measuring real (though
distinct) domains and not substitutes for one another. Ideally, both
should be modeled.
The fourth level in table 1, that of ontogenic factors, requires little
discussion because most of the HBM research has been focused on these
factors. Allusion was made earlier to the shortcomings of the HBM
because it ignores the social settings of the individual’s life and, further, it
imbues that life with a regularity and coherence that ofttimes are not
present. As an example, when the HBM was tested with cross-sectional
data from the Longitudinal Harlem Health Study, those individuals who
reported the most concern about HIV/AIDS were the ones who engaged
in riskier behaviors. While seemingly logical, this finding turns the HBM
on its head, since the model suggests that the most concerned individuals
will undertake risk avoidance practices.
Regardless of what other particular concerns arise from the ecological
model, one closing note must be sounded of a more general nature:
always leave room for serendipity. Though guided by theory, researchers
need to be open to the unexpected correlation-and to report it. Too
often, research is conducted either without any conceptual-theoretical
orientation or with too much of it, resulting in the neglect or oversight of
unexpected patterns that might appear in the data. While research needs
to be focused, it should be done with sufficient latitude for the
unexpected to come into view.
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