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

condition of receiving the coupons was that subjects not have been in
treatment during the previous year, clients recruited in this way did not
differ demographically or in terms of reported risk behavior from clients
who referred themselves to the clinics. Thus the results reported here
may be roughly reflective of those that would be obtained with an out-oftreatment
population. This is of some importance, since out-of-treatment
opiate addicts account for as many as six in seven opiate addicts in the
United States (Watters and Biernacki 1989).
A sociodemographic profile of the sample appears in table 1. The
ethnically diverse sample consisted mainly of males between 30 and 40
years old. About 60 percent of the sample had never been in methadone
maintenance treatment, and nearly half had made fewer than five attempts
to detoxify from heroin.
ACCURACY OF SELF-REPORTS
There is a critical need for accurate estimates of the prevalence of
behaviors that put people at risk of HIV infection. Reliable estimates are
needed to identify subpopulations to be targeted for intervention, to
discover correlates or antecedents of high-risk practices, and to properly
evaluate prevention programs to reduce transmission of HIV.
Behavioral research on transmission of HIV has been hampered by
dependence on people’s self-reports about their behavior and by the
researchers’ inability to verify those reports. The validity of self-reports
is suspect, since many risk behaviors include illicit or otherwise
stigmatized practices that respondents may be reluctant to acknowledge.
Methodological studies reveal that substantial underreporting of behavior
occurs when respondents find questions embarrassing or threatening. For
example, 50 percent of drunken drivers surveyed by Bradbum and
Sudman (1979) denied having been arrested, while 30 percent of those
who had gone through bankruptcy failed to acknowledge this in
interviews.
Studies that have attempted to document opiate addicts’ self-reports of
criminal or drug behavior (e.g., Amsel et al. 1976; Bale et al. 1976;
Maddux and Desmond 1975; Maisto et al. 1982) nevertheless have found
them to be remarkably accurate. Most of these studies, however,
gathered a relatively limited range of information in settings such as
prisons and drug treatment clinics where admitting drug habits or
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