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

in the United States was directed toward urgent issues of identifying and
enumerating “risk groups,” transmission routes, risk behaviors, and HIV
outcomes. Public health urgency, researchers’ familiarity and comfort
with quantitative methodology, and a lack of basic information on the
disease combined to create an atmosphere in which contextual issues
received relatively little attention.
While enumeration of risk behaviors is important for understanding the
extent of the epidemic, assessing the potential for spread, and targeting
prevention efforts, such efforts do not adequately clarify processes
underlying initiation and continuation of risk, recovery from risk, and
relapse to risk. Alternately, a focus on enumeration does not elucidate the
temporal and situational variability in risk behaviors. In sum, simply
counting risk behaviors does not adequately inform development of
prevention activities.
A CONTEXTUAL PERSPECTIVE MUST CONSIDER MULTIPLE
FACTORS THAT IMPINGE ON RISK
HIV risk behaviors are complex and cannot be adequately described by
focusing on enumeration of behaviors and groups at risk. A shift in
perspective is needed. This shift would move research from a primary
focus on individual factors toward a contextual perspective that fully
considers social and other environmental factors that impinge on risk
decisions. Risk behaviors are integrally tied to basic physiological,
social, and emotional functions of humans and are multiply determined.
A contextual perspective demands consideration of familial structure and
function, peer groups’ structures and processes, relationships with sex
partners, relationships with drug-using partners, and the effects of drug
use.
Beyond these individual and small group levels, contextual perspectives
require consideration of broader community factors such as economic
conditions, access to employment, needle availability, and similar factors
that impinge on and interact with interpersonal ones.
It is clear that to understand the context of HIV risk behaviors related to
the abuse of drugs, one must understand the epidemiology and natural
history of drug abuse itself. HIV risk is imposed upon and incorporated
into a larger context, and answers to questions about the temporal
variance of drug abuse, the natural history of drug abuse, norms among
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