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

same meaning may be extended to drug injectors who typically perform
needle cleaning immediately after injection. Researchers then might
assume that injecting drug users (IDUs) already are conscious about
needle cleanliness and that encouraging them to take the additional step
of using bleach is a relatively straightforward and effortless behavioral
change. However, for many drug injectors this postinjection rinse is not
conducted to disinfect the syringe; rather, its purpose is to unclog the
blood and drug residue from the needle so that it can be reused.
Although this may seem like a minor point, it indicates how even
behavior that appears obvious may in fact have very different meanings
for those engaged in it. Ethnographic research is particularly well-suited
for identifying and describing these kinds of cognitive differences.
In another illustration, the author found interpretations of what constitutes
sexual behavior may be, in part, dependent upon one’s sexual orientation,
the purpose for which a sexual act is performed, and the individual with
whom the act occurs. An interviewer on Denver’s National Institute on
Drug Abuse (NIDA)-funded cooperative agreement reported
inconsistencies among some subjects regarding their answers to a risk
assessment instrument’s questions on sexual behavior. He noticed that
gay women who exchange sex for money often revealed that they regard
sex as a pleasurable, intimate act they do with their female lover, while
the oral sex and heterosexual intercourse they engage in with male
customers is perceived as work (Anderson, personal communication,
January 1993). In fact, ethnographers in several cities have reported that
among both gay and heterosexual male and female subjects, oral sex and
anal sex are frequently viewed as something other than “real” sex
(Herdt 1992). Obviously, these differences in interpretation have
important implications for research aimed at measuring these high-risk
behaviors and intervention projects aimed at reducing them.
Perhaps the most notable example of the disparity in meanings among
drug injectors and public health researchers is over the term “syringe
sharing.” Throughout the 1980s HIV transmission among drug injectors
was directly linked to syringe sharing. From a biomedical perspective,
the term “sharing” succinctly captured the act that facilitates the
transmission of HIV among IDUs. Efforts to stop injectors from using
one another’s syringes were summarized in messages emphasizing “don’t
share your syringe.” As ethnographers began studying high-risk
injection, they began reporting that injectors do not necessarily use this
all-encompassing term to describe episodes in which a single syringe is
used. Many injectors do not consider that they are sharing if they use the
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