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

may regard a refusal to share a syringe as a sign of mistrust. On the other
hand, familiarity might enable drug injectors to be assertive about proper
needle hygiene. An individual’s position relative to the other people with
whom they are engaging in sex or drug use may also determine whether
they engage in risky activity. For example, a woman who is dependent
upon a male injector for access to drugs may be limited in her ability to
negotiate for safer drug use or the use of condoms (Guydish et al. 1991).
Non-drug-using members of a drug user’s personal network also may
influence drug-using behavior. For example, in San Juan, Puerto Rico,
IDUs who live with their families often frequent shooting galleries, where
high-risk drug use is common, in order to keep their drug use hidden
(Ann Finlinson, personal communication, May 2, 1994). This pattern is
common among injectors in Denver as well. However, among some
Denver injectors, an opposite trend is apparent. Some IDUs are able to
use drugs in their own homes because their families support them and
tolerate their drug use.
The specific setting in which drugs are used has been shown to play an
important role in influencing drug-using behavior. Researchers in several
cities have described the relationship between type of injecting location
and the drug-using behavioral complex that occurs there (Carlson et al. in
press; Clatts et al. in press; Des Jarlais and Friedman 1990; Oulette et al.
1991; Watters 1989). The shooting galleries and “get offs” (locally
known places injectors go to use drugs) that they describe vary in size,
organization, and function, and include establishments that service over
100 injectors a day as well as apartments or hotel rooms that are used
only by members of a closed drug-injecting network. Some shooting
galleries have tightly enforced rules governing injecting behavior; others
have no rules at all. Some of these establishments’ customers include
both crack smokers and injectors, some allow sexual barter to occur, and
some facilitate completely anonymous syringe sharing.
In Denver, drug injection occurs in a variety of settings, from relatively
small organized galleries to abandoned buildings, private homes, and the
backseats of automobiles. Each of these locations presents the injector
with certain conditions that may affect drug injection hygiene. For
example, the number of participants and their familiarity will vary with
the setting. Necessary ingredients like clean water may or may not be
present. Privacy for injection may be of particularly brief duration. IDUs
who inject in public areas, behind buildings, or in automobiles must do so
quickly if they are to avoid detection. As a result, the procedure is often
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