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

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subgroup relevant measure, a topic discussed later in this chapter as important in studying contextual effects. Laumann and colleagues (1993) have applied a social network and statistical strategy to investigate the undercount in HIV/AIDS prevalence estimates. Their strategy is an application of multiplicity sampling, and it is essentially useful as a proxy method for counting cases of a phenomenon too rare to measure by using normal area probability sampling procedures. This technique takes into account the respondent’s probability of selection into the sample and the number and characteristics of infected individuals identified in the network. Demographic characteristics of network cases from the multiplicity sample then are compared to those in official counts to estimate the location(s) and rate(s) of undercounting. Such a method, combined with what is known about geographic concentration of HIV/AIDS cases, might provide important insights not only into changing rates and undercounts but networks of infection diffusion as well. It is an example of how the requirements for valid and reliable HIV/AIDS reports might lead to improvisation of existing methods while preserving rigorous standards for reliability and validity in measurement. In that same article, Laumann and colleagues (1993) identified sources of bias or error in AIDS case reporting and specifically cited those factors they inferred as biasing against report of middle-class white infection at the various reporting levels. They cite an estimated undercount of up to 30 percent in 1989 across the three levels of reporting that comprise the Centers for Disease Control and Prevention’s (CDC’s) case counts (Laumann et al. 1993). Record bias of a different kind appeared in the author’s study and concerned the failure to report AIDS infection on African-American females’ death certificates in the mid-1980s. Deaths from pneumonia were reported for three female IDUs, and a fourth death was reported from acute renal failure with notations about narcotics use. The women were not tested for HIV/AIDS from 1985 to 1987; consequently, none of these deaths was ascribed to HIV infection or AIDS. Of course, failure to report an AIDS/HIV diagnosis on a death certificate also occurred before CDC’s modifications of the AIDS case definition (Centers for Disease Control 1987, 1992). The issues of question wording, question order, question context, and question format are discussed next, and all have repercussions for data 193
eliability. It seems obvious that questions need to be clear to the respondent, whether structured or nonstructured interview methods are used. For example, one woman self-identified as bisexual because “it’s only me and my husband.” Words should be selected that are familiar to the population(s) under study. Involving representatives of the study group during instrument preparation is one helpful approach. Pilot testing and pretesting are essential. In HIV/AIDS studies using questions—whether written or oral, structured or unstructured— deliberate steps need to be taken to vary the positive-negative direction of questions and prevent respondents’ inference of desirable responses. Risk behaviors, especially when evaluating before-after interventions, are quite transparent with respect to what is good and bad. The same information needs to be sought in different ways and in contexts that are not conducive to bias. A case in point occurred in the author’s research, when an individual gave an affirmative reply that he or she had increased condom use since hearing about AIDS (Brunswick, unpublished data). Earlier in the interview, however, the same respondent reported no current condom use. The author has little faith in direct questions about changing specified actions because of AIDS as a valid measure of actual behavior, although responses might be useful as measures of changing awareness of risk behaviors. Wording questions to elicit intentions to perform certain actions, behavior preferences, and actual behavior practices are distinctions demanding particular attention. Each of these questions reflects a different reality, just as the perceived environment (e.g., what is reported by the individual about another’s behavior) differs from objective reality. The distinctions can be informative, but these questions cannot be used as proxies for one another (e.g., Would you want to know if you were infected? Would you want your partner to know? Would you tell him/her? Did you tell him/her?). The order or context in which questions are presented also influences responses. Colasanto and colleagues (1992) elicited a significant difference (9 percent) in agreement responses by varying the order of survey questions regarding transmissibility of AIDS through blood donation. The difference hinged on whether a question about AIDS and blood donation preceded or followed another question about whether AIDS could be transmitted through blood transfusion. The sample who was asked about donation first had the higher proportion who accepted the erroneous mode of transmission. The authors believe that asking first 194
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National Institute on Drug Abuse RE
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ACKNOWLEDGMENT This monograph is ba
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Drug Use and HIV Risk Among Male Se
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Partners. The review was held April
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Inciardi, J.A.; Lockwood, D.; and P
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highlights the critical importance
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AUTHOR Richard H. Needle, Ph.D., M.
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Blower and colleagues (1991) have p
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Even in areas with low seroprevalen
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involves using a syringe to draw bl
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Hispanics were less likely to repor
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victimization through theft, violen
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sharing? When are needles deliberat
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Chitwood, D.D.; McCoy, C.B.; Inciar
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Page, J.B.; Smith, P.C.; and Kane,
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HIV/AIDS Risks Among Male, Heterose
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during that time, and the possibili
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All of these issues and considerati
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ecoming the norm for both male and
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the skin on his penis while having
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REFERENCES Ball, J.C., and Chambers
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Johnson, A.M.; Petherick, A.; David
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Vogt, M.W.; Craven, D.E.; Crawford,
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transmission from males to females
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(this volume), there is little atte
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Clayton, R.; Voss, H.; Robbins, C.;
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Female Drug Abusers and the Context
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have the data but interpret it supe
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important to examine current studie
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found in this study was low socioec
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who trade sex for crack; and simila
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esponsibilities in perspective. Suc
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Robles and colleagues (1990) examin
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The lack of rational thought separa
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Factors Associated With Sexual Risk
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Factors Associated With Poverty A n
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encouraging such women to leave the
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Hispanic women but extramarital aff
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coherence—the sense that life is
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the change agent may be a crucial f
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Centers for Disease Control and Pre
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Jemmott, J.B.; Jemmott, L.S.; Spear
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O’Leary, A.; Celentano, D.; Maiba
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Drug Use and HIV Risk Among Gay and
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with 34.6 percent of gay men and 28
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found among both hustlers and call
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Substance Use and HIV-Transmitting
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TABLE 1. Prevalence of substance us
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less than 2 percent of participants
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TABLE 2. Quantity of alcohol use am
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A fourth study of gay/bisexual men,
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in mind, however, that most of the
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seropositivity and reported NMPD us
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interaction and education than men
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Geographic differences found in the
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that they are intending or desirous
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enough is known in general about th
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REFERENCES Calzavara, L.M.; Coates,
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Ostrow, D.G.; Beltran, E.; Chmiel,
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Drug Use and HIV Risk Among Male Se
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prostitutes were HIV positive, as c
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Trade hustlers are usually heterose
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TABLE 1. Number of Completed Interv
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diagnosed slightly more often than
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TABLE 2. Injection Drug Use by Type
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By the 100th interview, the screeni
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SUMMARY AND CONCLUSIONS In general,
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Plant, M. Sex work, alcohol, drugs
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HIV Risk in Drug-Using Adolescents
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AUTHOR Vincent L. Smeriglio, Ph.D.
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comprise 23 percent of all adolesce
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232 (18 percent) of the cases; and
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Although these data provide an over
Page 147 and 148: Most of these were unprotected sexu
Page 149 and 150: national epidemiologic survey of hi
Page 151 and 152: Hawkins et al. 1992; Newcomb et al.
Page 153 and 154: higher rates of HIV/AIDS in adolesc
Page 155 and 156: Boyer, C.B. Psychosocial, behaviora
Page 157 and 158: Irwin, C.E., Jr., and Shafer, M.A.
Page 159 and 160: Zweig Greenberg, MS.; Singh, T.; Ht
Page 161 and 162: the types of intervention strategie
Page 163 and 164: from a study group of 52 youths who
Page 165 and 166: forearm during a sexual episode. At
Page 167 and 168: I was nice looking, like I can do a
Page 169 and 170: It is unclear whether the disinhibi
Page 171 and 172: continual sexual dysfunction was re
Page 173 and 174: TWEAKING, FREAKING, AND OVER-AMPING
Page 175 and 176: highway of love. It’s like, I’d
Page 177 and 178: Unprotected sexual activity is more
Page 179 and 180: alternatives and opportunities, and
Page 181 and 182: the night and food for the morning.
Page 183 and 184: 7. also can help youths explore and
Page 185 and 186: Jessor, R., and Jessor, S.L. Proble
Page 187 and 188: AUTHORS Mary Jane Rotheram-Borus, P
Page 189 and 190: Brunswick goes on to discuss the le
Page 191 and 192: permission-giving introductions to
Page 193 and 194: conversion and perhaps even serocon
Page 195 and 196: TABLE 1. Ecological paradigm of con
Page 197: TECHNICAL ISSUES Technical issues i
Page 201 and 202: sometimes as many as three zip code
Page 203 and 204: Resources and effort are required t
Page 205 and 206: Brunswick, A.F.; Lewis, C.S.; and M
Page 207 and 208: The Context of Risk: Ethnographic C
Page 209 and 210: same meaning may be extended to dru
Page 211 and 212: THE CONTEXT OF RISK Context is an a
Page 213 and 214: hurried, and adequate needle cleani
Page 215 and 216: degrading sexual acts, poignantly m
Page 217 and 218: searched me and I had stashed the c
Page 219 and 220: REFERENCES Agar, M. The Professiona
Page 221 and 222: Ouellet, L. J.; Jimenez, A.D.; John
Page 223 and 224: Assessing the Reliability and Valid
Page 225 and 226: TABLE 1. Sociodemographic profile o
Page 227 and 228: Table 2 shows percentage agreement
Page 229 and 230: FORENSIC TECHNIQUES TO DOCUMENT SEL
Page 231 and 232: cross-tabulated with dichotomous me
Page 233 and 234: TABLE 6. Relationship of question t
Page 235 and 236: aggravate self-presentation bias. T
Page 237 and 238: TABLE 8. Percent of subjects report
Page 239 and 240: intercourse, and since anal interco
Page 241 and 242: Future Directions for Studies on th
Page 243 and 244: abusers, and other variables are ne
Page 245 and 246: Behavior patterns can be clarified
Page 247 and 248: As Des Jarlais noted, designs and a
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strengths within a setting or indiv
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National Institute on While limited
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62 NEUROSCIENCE METHODS IN DRUG ABU
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89 BIOLOGICAL VULNERABILITY TO DRUG
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111 MOLECULAR APPROACHES TO DRUG AB
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127 PROGRESS AND ISSUES IN CASE MAN
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NIH Publication No. 94-3750 Printed
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