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

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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 213
REFERENCES Agar, M. The Professional Stranger: An Informal Introduction to Ethnography. New York: Academic Press, 1980. Anderson, E. Streetwise. Chicago: University of Chicago, 1990. Bourgois, P. In search of Horatio Alger: Culture and ideology in the crack economy. Contemp Drug Probl 16(4):619-651, 1989a. Bourgois, P. “Just Another Night on Crack Street.” New York Times Magazine, 12 November 1989b. p. 61. Carlson, R.G. “HIV Needle Risk Behavior among IDUs in West Central Ohio: An Ethnographic Overview.” Paper presented at the Conference on AIDS and Anthropology in the United States. Atlanta, GA, October 16, 1991. Carlson, R.G.; Siegal, H.A.; and Falck, R.S. Ethnography, epidemiology and public policy: Needle use practices and risk reduction among IV drug users in the midwest. In: Feldman, D.A., ed. Anthropology and Global AIDS Policy. Westport, CT: Greenwood Press, in press. Clatts, M.; Davis, W.R.; Deren, S.; Goldsmith, D.S.; and Tortu, S. AIDS risk behavior among drug injectors in New York City: Critical gaps in prevention policy. In: Feldman, D., ed. Anthropology and Global AIDS Policy. Westport, CT: Greenwood Press, in press. Des Jarlais, D.C. and Friedman, S.R. Shooting galleries and AIDS: Infection probabilities and ‘tough’ policies. Am J Public Health 80: 142-144, 1990. Des Jarlais, D.C. and Friedman, S.R. AIDS and legal access to sterile drug injection equipment. Ann Am Acad Political Soc Sci 521: 42-65, 1992. Des Jarlais, D.C.; Friedman, S.; and Strug, D. AIDS and needle sharing within the IV drug use subculture. In: Feldman, D., and Johnson, T., eds. The Social Dimension of AIDS: Method and Theory. New York: Praeger, 1986. Feldman, H.W., and Biemacki, P. The ethnography of needle sharing among intravenous drug users and implications for public policies and intervention strategies. In: Battjes, R.J., and Pickens, R.W., eds. Needle Sharing Among Intravenous Drug Abusers: National and International Perspectives. National Institute on Drug Abuse Research Monograph No. 80. DHHS Pub. No. (ADM)88-1567. Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1988. Fernando, D. Fundamental limitations of needle-exchange programs as a strategy for HIV prevention among IVDUs in the US. AIDS Public Pol J 6:116-120, 1991. 214
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National Institute on Drug Abuse RE
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ACKNOWLEDGMENT This monograph is ba
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Drug Use and HIV Risk Among Male Se
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Partners. The review was held April
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Inciardi, J.A.; Lockwood, D.; and P
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highlights the critical importance
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AUTHOR Richard H. Needle, Ph.D., M.
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Blower and colleagues (1991) have p
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Even in areas with low seroprevalen
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involves using a syringe to draw bl
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Hispanics were less likely to repor
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victimization through theft, violen
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sharing? When are needles deliberat
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Chitwood, D.D.; McCoy, C.B.; Inciar
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Page, J.B.; Smith, P.C.; and Kane,
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HIV/AIDS Risks Among Male, Heterose
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during that time, and the possibili
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All of these issues and considerati
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ecoming the norm for both male and
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the skin on his penis while having
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REFERENCES Ball, J.C., and Chambers
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Johnson, A.M.; Petherick, A.; David
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Vogt, M.W.; Craven, D.E.; Crawford,
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transmission from males to females
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(this volume), there is little atte
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Clayton, R.; Voss, H.; Robbins, C.;
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Female Drug Abusers and the Context
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have the data but interpret it supe
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important to examine current studie
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found in this study was low socioec
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who trade sex for crack; and simila
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esponsibilities in perspective. Suc
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Robles and colleagues (1990) examin
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The lack of rational thought separa
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Factors Associated With Sexual Risk
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Factors Associated With Poverty A n
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encouraging such women to leave the
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Hispanic women but extramarital aff
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coherence—the sense that life is
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the change agent may be a crucial f
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Centers for Disease Control and Pre
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Jemmott, J.B.; Jemmott, L.S.; Spear
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O’Leary, A.; Celentano, D.; Maiba
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Drug Use and HIV Risk Among Gay and
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with 34.6 percent of gay men and 28
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found among both hustlers and call
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Substance Use and HIV-Transmitting
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TABLE 1. Prevalence of substance us
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less than 2 percent of participants
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TABLE 2. Quantity of alcohol use am
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A fourth study of gay/bisexual men,
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in mind, however, that most of the
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seropositivity and reported NMPD us
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interaction and education than men
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Geographic differences found in the
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that they are intending or desirous
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enough is known in general about th
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REFERENCES Calzavara, L.M.; Coates,
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Ostrow, D.G.; Beltran, E.; Chmiel,
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Drug Use and HIV Risk Among Male Se
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prostitutes were HIV positive, as c
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Trade hustlers are usually heterose
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TABLE 1. Number of Completed Interv
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diagnosed slightly more often than
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TABLE 2. Injection Drug Use by Type
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By the 100th interview, the screeni
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SUMMARY AND CONCLUSIONS In general,
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Plant, M. Sex work, alcohol, drugs
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HIV Risk in Drug-Using Adolescents
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AUTHOR Vincent L. Smeriglio, Ph.D.
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comprise 23 percent of all adolesce
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232 (18 percent) of the cases; and
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Although these data provide an over
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Most of these were unprotected sexu
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national epidemiologic survey of hi
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Hawkins et al. 1992; Newcomb et al.
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higher rates of HIV/AIDS in adolesc
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Boyer, C.B. Psychosocial, behaviora
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Irwin, C.E., Jr., and Shafer, M.A.
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Zweig Greenberg, MS.; Singh, T.; Ht
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the types of intervention strategie
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from a study group of 52 youths who
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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
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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 and 210: same meaning may be extended to dru
Page 211 and 212: THE CONTEXT OF RISK Context is an a
Page 213 and 214: hurried, and adequate needle cleani
Page 215 and 216: degrading sexual acts, poignantly m
Page 217: searched me and I had stashed the c
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
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