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

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TABLE 2. Percent agreement in answers to questions about selected HIV risk behaviors, T1 and T2 (N = 94) Behaviors Injection behaviors Borrowed dirty syringe Shared cotton or cooker Sexual behaviors 2 or more sexual partners Used condoms some Used condoms 100 percent Anal intercourse *Agreement significant at p 0.001. Ever Past 6 Past 30 months days 87.9* 82.7* 77.6* 82.8* 88.9 87.7* 92.3* 84.9* 91.9* 97.0* TABLE 3. Concordance of self-reports of monogamous couples about selected sexual behaviors (N = 29) Sexual Behaviors Sexually abstinent, past 30 days Used condoms some, past 30 days Used condoms 100 percent, past 30 days Oral sex, past 30 days Anal intercourse, past 6 months *Agreement significant at p 0.001. Percent agreement 100.0* 87.0* 91.3* 79.3* 93.1* 36 percent of respondents reported that they had borrowed a syringe themselves, 63 percent said that they had observed others borrowing (p < 0.001); “borrowing” refers to using a needle that someone else had used without first cleaning it with bleach. While it is difficult to attribute this difference entirely to underreporting of their own risk behavior, it is probable that respondents had far fewer opportunities to observe others’ ‘behavior than their own. 223
FORENSIC TECHNIQUES TO DOCUMENT SELF-REPORTS OF NEEDLE SHARING The authors attempted to verify self-reported needle sharing by performing forensic tests on syringes provided by drug users to determine whether the tests corroborated what drug users reported they had done with the syringes (Gibson et al. 1991). A convenience sample was recruited in a San Francisco street setting and asked to provide syringes for an anonymous study of injection equipment. Fifty-nine drug users presented an average of 1.7 syringes for inspection, with 31 presenting at least one syringe containing visible blood. With each drug user, a staff member selected a single syringe as the basis for a brief interview concerning its use by the donor and others, After completing the 10-item interview, drug users provided a reference fingerstick blood specimen and were paid $10 for their time. They were not told of the specific purpose of the study. Blood residue in the syringes was analyzed for genetic traits using tests for the isoenzyme phosphoglumatase (PGM), Gamma marker (Gm) and Kappa marker (Km) immunoglobulin, and HLA-DQ alpha-type. Of the 31 syringes, 27 contained sufficient blood to conduct one or more of the tests. Genetic markers were obtained in 10 PGM tests, 23 Gm tests, 25 Km tests, and 23 DQ-alpha tests. The reference blood samples provided by the donors of the 27 syringes were analyzed to determine the genetic traits of the donors. In only four syringes were there genetic traits of two drug users. The analysis indicated, however, that 15 of the 27 syringes had been used by someone other than the donor. Table 4 shows a cross-tabulation of the laboratory results with self-report of sharing a dirty needle (i.e., a needle that had been used by someone else). The table indicates a reasonable degree of agreement between the laboratory results and self-reports, with there being a correspondence in 20 of 27 cases (74 percent). However, more than a third (6 out of 17) of drug users who denied sharing were contradicted by the laboratory tests. Moreover, in six of the seven cases where there was a discrepancy between the lab test and self-report, the drug user denied that he or she had borrowed. Self-reports of needle sharing thus appear to understate “true” levels of sharing. 224
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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
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I was nice looking, like I can do a
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It is unclear whether the disinhibi
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continual sexual dysfunction was re
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TWEAKING, FREAKING, AND OVER-AMPING
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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 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 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: Table 2 shows percentage agreement
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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