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

More documents

Recommendations

Info

syringe first, if they share with their sexual partners, if they jointly purchase a syringe, if they anonymously use a previously used needle, or if they clean a jointly used syringe with bleach. Some behavioral scientists described syringe sharing as a ritualized social practice, implying that the exchange of a syringe between injectors was a conscious act of reciprocity. In this interpretation, syringe sharing was thought to function as a means for injectors to bond and develop trust (Des Jarlais et al. 1986; Howard and Borges 1972). Observations of injecting situations and detailed interviews with injectors led several ethnographers to suggest additional explanations for this behavior. They found that, in many cases, syringe sharing is motivated by the need to get high, and has little to do with ritual or cementing social relationships (Carlson et al. in press; Clatts et al. in press; Fernando 1991; Kane and Mason 1992; Koester 1992, 1994; Murphy 1987; Page et al. 1990). Ethnographers have suggested the terms “needle transfer” and “needle circulation” as more accurately describing the multiple ways injectors pass syringes among themselves (Carlson 1991; Carlson et al. in press). Usually, the IDU who gives a syringe to another injector does not want it back. Needle pooling describes how injectors use common stocks of used syringes available at shooting galleries as well as what happens when an injector “stashes” a syringe in a location where other IDUs can find it (Page et al. 1990). Studies by Carlson and colleagues (in press) and by Koester (1994) explained multiple reasons, besides HIV, that injectors have for not sharing their syringes. Used syringes are more difficult and painful to use because the point quickly becomes dull, an important consideration for injectors who experience difficulty locating a vein or who want to prolong the use of their remaining uncollapsed veins. Also, the most common syringes now used by injectors are disposable insulin syringes that become inoperable from repeated use; needles clog and the rubber plunger begins to lose its pliancy and thus its suction after more than a few injections. These illustrations suggest the importance of understanding the meaning of behavior from the point of view of those who engage in it and confirm the necessity of identifying and understanding the “complex and broader constraints” influencing these behaviors (Kane and Mason 1992, p. 201). Identifying when sex becomes work or when syringe sharing becomes an anonymous act requires an understanding of the context in which these behaviors take place. 205
THE CONTEXT OF RISK Context is an abstract concept used to describe the environment in which human behavior occurs. It refers to those conditions and circumstances that affect action and thought. As such, context is manifested in different dimensions and on many levels of human experience. These conditions may be personal, social, or part of the physical environment; they may operate on a local or microlevel; or they may be macrolevel structural forces. Contextual factors are not static. Factors influencing people’s lives always are changing; people are constantly adjusting and adapting as well as resisting the conditions and circumstances affecting them. By grounding drug users’ beliefs and behavior within their everyday reality-the conditions and circumstances in which they live-researchers can resist the tendency to explain their views and behaviors as evidence of some unique cultural system that can only be comprehended through its own internal logic. Instead, researchers can demystify and in a sense “detribalize” drug users, rather than see them as some exotic but deviant other. They can begin to view much of users’ behavior and beliefs as pragmatic responses to their life circumstances. CONTEXT AT THE MICROLEVEL A variety of contextual factors has been identified by ethnographers as influencing high-risk drug injecting. These include social and situational factors at the immediate microlevel as well as macrolevel social, economic, and political forces. Immediate, microlevel contextual factors include the stage users are at in their drug use, the emotional or physiological state of the injector at the time of injection, the nature of the relationships between users, the physical and social setting in which drugs are used, the kinds of drugs being injected, injectors’ economic status, and the hustles or occupations they employ. For example, an injector’s physiological state may affect significantly an injection episode. It is unlikely that an injector who is in withdrawal, desperate to get high, or intoxicated will take the precautions necessary to reduce the possibility of HIV contamination. The social network or group within which drugs are used and obtained may influence members’ injection behavior. The relationship between the members of a network may determine whether they use common injecting equipment. Injectors who are sexual partners or close friends 206
Page 1 and 2:
National Institute on Drug Abuse RE
Page 3 and 4:
ACKNOWLEDGMENT This monograph is ba
Page 5 and 6:
Drug Use and HIV Risk Among Male Se
Page 7 and 8:
Partners. The review was held April
Page 9 and 10:
Inciardi, J.A.; Lockwood, D.; and P
Page 11 and 12:
highlights the critical importance
Page 13 and 14:
AUTHOR Richard H. Needle, Ph.D., M.
Page 15 and 16:
Blower and colleagues (1991) have p
Page 17 and 18:
Even in areas with low seroprevalen
Page 19 and 20:
involves using a syringe to draw bl
Page 21 and 22:
Hispanics were less likely to repor
Page 23 and 24:
victimization through theft, violen
Page 25 and 26:
sharing? When are needles deliberat
Page 27 and 28:
Chitwood, D.D.; McCoy, C.B.; Inciar
Page 29 and 30:
Page, J.B.; Smith, P.C.; and Kane,
Page 31 and 32:
HIV/AIDS Risks Among Male, Heterose
Page 33 and 34:
during that time, and the possibili
Page 35 and 36:
All of these issues and considerati
Page 37 and 38:
ecoming the norm for both male and
Page 39 and 40:
the skin on his penis while having
Page 41 and 42:
REFERENCES Ball, J.C., and Chambers
Page 43 and 44:
Johnson, A.M.; Petherick, A.; David
Page 45 and 46:
Vogt, M.W.; Craven, D.E.; Crawford,
Page 47 and 48:
transmission from males to females
Page 49 and 50:
(this volume), there is little atte
Page 51 and 52:
Clayton, R.; Voss, H.; Robbins, C.;
Page 53 and 54:
Female Drug Abusers and the Context
Page 55 and 56:
have the data but interpret it supe
Page 57 and 58:
important to examine current studie
Page 59 and 60:
found in this study was low socioec
Page 61 and 62:
who trade sex for crack; and simila
Page 63 and 64:
esponsibilities in perspective. Suc
Page 65 and 66:
Robles and colleagues (1990) examin
Page 67 and 68:
The lack of rational thought separa
Page 69 and 70:
Factors Associated With Sexual Risk
Page 71 and 72:
Factors Associated With Poverty A n
Page 73 and 74:
encouraging such women to leave the
Page 75 and 76:
Hispanic women but extramarital aff
Page 77 and 78:
coherence—the sense that life is
Page 79 and 80:
the change agent may be a crucial f
Page 81 and 82:
Centers for Disease Control and Pre
Page 83 and 84:
Jemmott, J.B.; Jemmott, L.S.; Spear
Page 85 and 86:
O’Leary, A.; Celentano, D.; Maiba
Page 87 and 88:
Drug Use and HIV Risk Among Gay and
Page 89 and 90:
with 34.6 percent of gay men and 28
Page 91 and 92:
found among both hustlers and call
Page 93 and 94:
Substance Use and HIV-Transmitting
Page 95 and 96:
TABLE 1. Prevalence of substance us
Page 97 and 98:
less than 2 percent of participants
Page 99 and 100:
TABLE 2. Quantity of alcohol use am
Page 101 and 102:
A fourth study of gay/bisexual men,
Page 103 and 104:
in mind, however, that most of the
Page 105 and 106:
seropositivity and reported NMPD us
Page 107 and 108:
interaction and education than men
Page 109 and 110:
Geographic differences found in the
Page 111 and 112:
that they are intending or desirous
Page 113 and 114:
enough is known in general about th
Page 115 and 116:
REFERENCES Calzavara, L.M.; Coates,
Page 117 and 118:
Ostrow, D.G.; Beltran, E.; Chmiel,
Page 119 and 120:
Drug Use and HIV Risk Among Male Se
Page 121 and 122:
prostitutes were HIV positive, as c
Page 123 and 124:
Trade hustlers are usually heterose
Page 125 and 126:
TABLE 1. Number of Completed Interv
Page 127 and 128:
diagnosed slightly more often than
Page 129 and 130:
TABLE 2. Injection Drug Use by Type
Page 131 and 132:
By the 100th interview, the screeni
Page 133 and 134:
SUMMARY AND CONCLUSIONS In general,
Page 135 and 136:
Plant, M. Sex work, alcohol, drugs
Page 137 and 138:
HIV Risk in Drug-Using Adolescents
Page 139 and 140:
AUTHOR Vincent L. Smeriglio, Ph.D.
Page 141 and 142:
comprise 23 percent of all adolesce
Page 143 and 144:
232 (18 percent) of the cases; and
Page 145 and 146:
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 and 198: TECHNICAL ISSUES Technical issues i
Page 199 and 200: eliability. It seems obvious that q
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: same meaning may be extended to dru
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
Page 249 and 250: strengths within a setting or indiv
Page 251 and 252: National Institute on While limited
Page 253 and 254: 62 NEUROSCIENCE METHODS IN DRUG ABU
Page 255 and 256: 89 BIOLOGICAL VULNERABILITY TO DRUG
Page 257 and 258: 111 MOLECULAR APPROACHES TO DRUG AB
Page 259 and 260: 127 PROGRESS AND ISSUES IN CASE MAN
Page 261:
NIH Publication No. 94-3750 Printed
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?