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

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than whites to have multiple non-IDU female partners. White males were more likely to have multiple IDU female partners. Several studies have reported the low use of condoms among heterosexual male IDUs. Ross and colleagues (1992) compared IDUs across sexual orientation groups and reported sexual risk related to condom nonuse was lowest for homosexual men, intermediate for bisexual men, and highest for heterosexual men; i.e., heterosexual men were least likely to use condoms. Heterosexual men were, however, least likely to have multiple partners and to have anal sex. Reported rates of condom use vary by study; however, most report nonuse at more than two-thirds. Factors that lead to condom use remain unclear. Chapman and colleagues (1990) found that in a general heterosexual sample, three conceptually coherent factors (condom use as a positive action, condom use as a cue to embarrassment, and condom use as antithetical to good sex) discriminated between users and nonusers. Condom use has been reported to be associated with voluntary testing for HIV, average or more than average fear of sexually transmitted diseases (STDs), and knowledge of HIV carrier status in personal relations (Moatti et al. 1991). This study included 1,088 heterosexuals with multiple partners (IDU status unknown). Watkins and colleagues (1992) compared in- and out-of-treatment IDUs on their sexual risk behaviors. Out-of-treatment IDUs reported significantly more partners than in-treatment IDUs and more often exchanged sex for money or drugs. Alcabes and colleagues (1992) also compared in-treatment to out-of-treatment IDU samples and found that the out-of-treatment IDUs tended to be younger, male, and African American. However, associations between HIV-1 seropositivity and a series of demographic and drug-using characteristics were similar in direction and magnitude among subjects currently in treatment and those not in treatment. Lewis and Watters (1991) reported that sexual risktaking behavior in a sample of IDUs was associated with recent increases in both injecting and smoking cocaine. Clearly the concept of risk perception is important. Connors (1992) described the overlap of the risks associated with AIDS transmission with other risks common in the use of intravenous (IV) drugs (risks associated with stealing, dealing drugs, carrying a needle, copping drugs, and borrowing needles). On a daily basis, IDUs risk arrest, overdose, and 17
victimization through theft, violence, and illnesses related to their drug use. A person may borrow a needle from someone because the borrower does not want to assume the risk for illegal possession of a syringe. Similarly, the probability of a fatal overdose is reduced if someone else with whom they share a needle is present. The immediate costs of arrest, overdose, or dope sickness are usually more salient than the long-term risks to one’s health (hepatitis, endocarditis, AIDS). Risk taking and risk perception are also likely to change over time, as a person’s dependency on a substance increases and acculturation to the IDU community increases. CHANGES IN AIDS RISK BEHAVIORS There is a growing literature on the effectiveness of intervention programs whose goals are to impact on the AIDS risk behaviors of IDUs and their sexual partners. While it is beyond the scope of this chapter to review this literature, it is nevertheless instructive to review the findings of a study that summarizes the impact of the National AIDS Demonstration Research (NADR) projects (Stephens et al. 1993). These projects targeted IDUs and their sexual partners with a variety of AIDS prevention messages delivered in a variety of innovative educational programs. Twenty-eight NADR programs contributed longitudinal data (measured by standardized interviews at baseline and 6-month followup) on 13,475 IDUs and 1,637 sexual partners. Analysis indicated significant changes over the 6-month period in HIV-related risk behaviors among IDUs, including frequency of injecting drugs, the use of noninjected drugs, the use of borrowed injection equipment, and the number of sexual partners reported by the subject. Significant increases were observed in the use of new (rather than previously used) needles, the use of bleach to clean injection equipment between uses, and the use of condoms. The magnitude of change in many of the risk behaviors was very large. For example, at baseline, 54 percent of the total sample indicated that they had shared needles with two or more different persons during the preceding 6 months; at followup, the percentage had dropped to 23 percent. In particular, changes in risky needle-related behaviors were more dramatic than the changes in the risky sexual behaviors. Nevertheless, there were significant numbers of subjects who did not reduce their AIDS risk behaviors. 18
Page 1 and 2: National Institute on Drug Abuse RE
Page 3 and 4: ACKNOWLEDGMENT This monograph is ba
Page 5 and 6: Drug Use and HIV Risk Among Male Se
Page 7 and 8: Partners. The review was held April
Page 9 and 10: Inciardi, J.A.; Lockwood, D.; and P
Page 11 and 12: highlights the critical importance
Page 13 and 14: AUTHOR Richard H. Needle, Ph.D., M.
Page 15 and 16: Blower and colleagues (1991) have p
Page 17 and 18: Even in areas with low seroprevalen
Page 19 and 20: involves using a syringe to draw bl
Page 21: Hispanics were less likely to repor
Page 25 and 26: sharing? When are needles deliberat
Page 27 and 28: Chitwood, D.D.; McCoy, C.B.; Inciar
Page 29 and 30: Page, J.B.; Smith, P.C.; and Kane,
Page 31 and 32: HIV/AIDS Risks Among Male, Heterose
Page 33 and 34: during that time, and the possibili
Page 35 and 36: All of these issues and considerati
Page 37 and 38: ecoming the norm for both male and
Page 39 and 40: the skin on his penis while having
Page 41 and 42: REFERENCES Ball, J.C., and Chambers
Page 43 and 44: Johnson, A.M.; Petherick, A.; David
Page 45 and 46: Vogt, M.W.; Craven, D.E.; Crawford,
Page 47 and 48: transmission from males to females
Page 49 and 50: (this volume), there is little atte
Page 51 and 52: Clayton, R.; Voss, H.; Robbins, C.;
Page 53 and 54: Female Drug Abusers and the Context
Page 55 and 56: have the data but interpret it supe
Page 57 and 58: important to examine current studie
Page 59 and 60: found in this study was low socioec
Page 61 and 62: who trade sex for crack; and simila
Page 63 and 64: esponsibilities in perspective. Suc
Page 65 and 66: Robles and colleagues (1990) examin
Page 67 and 68: The lack of rational thought separa
Page 69 and 70: Factors Associated With Sexual Risk
Page 71 and 72: Factors Associated With Poverty A n
Page 73 and 74:
encouraging such women to leave the
Page 75 and 76:
Hispanic women but extramarital aff
Page 77 and 78:
coherence—the sense that life is
Page 79 and 80:
the change agent may be a crucial f
Page 81 and 82:
Centers for Disease Control and Pre
Page 83 and 84:
Jemmott, J.B.; Jemmott, L.S.; Spear
Page 85 and 86:
O’Leary, A.; Celentano, D.; Maiba
Page 87 and 88:
Drug Use and HIV Risk Among Gay and
Page 89 and 90:
with 34.6 percent of gay men and 28
Page 91 and 92:
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
Page 109 and 110:
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
Page 115 and 116:
REFERENCES Calzavara, L.M.; Coates,
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Ostrow, D.G.; Beltran, E.; Chmiel,
Page 119 and 120:
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
Page 155 and 156:
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
Page 161 and 162:
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
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Unprotected sexual activity is more
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alternatives and opportunities, and
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the night and food for the morning.
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7. also can help youths explore and
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Jessor, R., and Jessor, S.L. Proble
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AUTHORS Mary Jane Rotheram-Borus, P
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Brunswick goes on to discuss the le
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permission-giving introductions to
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conversion and perhaps even serocon
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TABLE 1. Ecological paradigm of con
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TECHNICAL ISSUES Technical issues i
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eliability. It seems obvious that q
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sometimes as many as three zip code
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Resources and effort are required t
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Brunswick, A.F.; Lewis, C.S.; and M
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The Context of Risk: Ethnographic C
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same meaning may be extended to dru
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THE CONTEXT OF RISK Context is an a
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hurried, and adequate needle cleani
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degrading sexual acts, poignantly m
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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 and 228:
Table 2 shows percentage agreement
Page 229 and 230:
FORENSIC TECHNIQUES TO DOCUMENT SEL
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cross-tabulated with dichotomous me
Page 233 and 234:
TABLE 6. Relationship of question t
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aggravate self-presentation bias. T
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TABLE 8. Percent of subjects report
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intercourse, and since anal interco
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Future Directions for Studies on th
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abusers, and other variables are ne
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Behavior patterns can be clarified
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As Des Jarlais noted, designs and a
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strengths within a setting or indiv
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National Institute on While limited
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62 NEUROSCIENCE METHODS IN DRUG ABU
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89 BIOLOGICAL VULNERABILITY TO DRUG
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111 MOLECULAR APPROACHES TO DRUG AB
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127 PROGRESS AND ISSUES IN CASE MAN
Page 261:
NIH Publication No. 94-3750 Printed
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The Context of HIV Risk Among Drug Users and Their Sexual Partners

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