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

sometimes as many as three zip codes. Collecting geographic area
information, therefore, involves different units of analysis that have to be
disaggregated or reaggregated into uniform measures.
Another consideration is that appropriate boundaries of HIV risk areas are
yet to be determined. High-rate cities have been identified but, as the
National Research Council (NRC) (1993) report emphasized, cases are
concentrated in certain areas within those cities. These areas coincide
with concentrations of gays or impoverished minority groups. A future
study may determine whether these concentrated areas conform better to
census tract boundaries, zip code boundaries, health areas, or none of the
above. Investigating the natural geographic boundaries of infection
might yield information about the spread of disease as well as the role of
spatial factors (e.g., crack houses, sex trade) in that spread (National
Research Council 1993; Wallace 1988). The author’s study compared
proportions of infected and noninfected individuals in New York City
neighborhoods identified as high infection centers. The study found that
equivalent proportions of infected and uninfected individuals resided in
those neighborhoods.
Perhaps the preeminent technical challenge facing researchers is the need
for ethnic, gender, and cultural sensitivity and specificity in research
methods. Ethnogender response differences arise from the differential
norms governing the same behaviors that are of particular interest and
relevance in assessing HIV/AIDS risk. These differences are more
readily understood in reference to the ecological model that enlightens a
comparison of HIV/AIDS infection among gays and minorities and
between different minorities as well (Diaz et al. 1993).
Gender differences are important both within and among cultural groups.
One example from the author’s experience concerns the honesty that
African-American men and women attributed to replies regarding sexual
behavior (Brunswick, unpublished data). The differences were split not
only by gender but, as further evidence of differential gender norms, by
HIV infection status as well. When asked how honestly they thought
others in the survey had answered questions about sexual behavior,
infected men were more likely to answer “completely honestly”
(31 percent) compared to uninfected men (12 percent) and infected
women, none of whom attributed complete honesty to others. Uninfected
women (20 percent) were more likely than infected women and
uninfected men to attribute complete honesty to others in reporting sexual
experiences. The question was intended as an indirect measure of
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