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

syringes. One pharmacy located close to a high-profile drug copping
scene kept syringes at the front counter but charged $1.50 a piece or
$5 for a 10-pack of U-100 insulin syringes. In contrast, pharmacies
attached to national food chain stores sold lo-packs of insulin syringes
for as little as $1.70. However, not all of these chain stores would sell to
injectors.
CONCLUSION
Attempting to understand the multiple reasons why risk reduction is not
necessarily easy to achieve or maintain requires that researchers identify
and analyze impediments to behavior change, and thus examine the larger
contextual dimensions of drug users’ lives. What microlevel and
macrolevel conditions and circumstances affect people’s ability to make
potentially life-preserving changes? By emphasizing context in their
studies, researchers can temper the tendency to explain high-risk behavior
and the attitudes that support it as owing to personal inadequacy or
maladaptive subcultural traits.
By identifying significant contextual factors and describing how they
exacerbate or inhibit risk behavior, researchers can augment current
interventions aimed at individual behavior change. Intervention
programs can be developed to support individuals’ attempts at risk
reduction by addressing the local conditions that encourage risk behavior
while at the same time promoting conditions that encourage risk
reduction. For example, in other forums, the author has advocated a
reassessment of current paraphernalia laws that make syringes difficult to
obtain or illegal to possess. Because of the HIV epidemic, these laws
may no longer serve the public interest. Likewise, pharmacists in states
where syringes are sold legally could be encouraged not to discriminate
against IDUs. Clearly, such proactive approaches must be localized.
They will only be effective if they are based on locally significant
behavioral influences and if information provided by active drug users is
considered in these approaches.
Ethnographic research has made substantial contributions to the fields of
epidemiology, public health, and HIV prevention. By giving drug users a
voice, ethnographic research has provided a means for those at risk to
inform the research and interventions. By describing how the
environment in which people live influences their behavior,
ethnographers have presented the field of public health with new
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