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

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variables should be selected and studies designed in a manner that allows results to be used systematically to inform and develop a theoretical framework. CONTEXTUAL ISSUES SHOULD BE UNDERSTOOD AND EXAMINED WITH BOTH QUALITATIVE AND QUANTITATIVE METHODOLOGIES One of the benefits of a technical review is that researchers with various backgrounds and perspectives exchange ideas, and this process highlights the complementarity of approaches. Quantitative and qualitative research methods are often presented as opposite ends of a continuum, but such a presentation ignores the fact that they are both methods of systematic inquiry and learning whose shared opposite is ignorance. From that perspective, it becomes incumbent on researchers to use multiple research approaches to address a problem. Important concepts in this regard are those of “experience near” and “experience distant,” terms used by anthropologists to indicate proximity to the language and concepts of the observed subject. Experience-near language, such as backloading, is close to the world view and phenomenology of the subject, whereas experience-distant language reflects the observer’s terminology and conceptual organization. Qualitative researchers use these ideas to evaluate how well their observations reflect the subject’s experiences and interpretations and not only the researcher’s views. Ethnographers present at the technical review stressed the importance of experience-near language and thinking in order to clarify contextual issues and to raise hypotheses. They also noted that data provide insights into different levels of contextual determinants. For example, the researcher arrives at different conclusions if a self-report is taken as objective fact rather than as the subjects’ world view. People neither recall nor report accurately and reliably their experiences and motivations, tending to err in reports and to respond to environmental contingencies, some of which they are not aware. They often deny the influence of stimulus control and psychological motivations that can be objectively related to their behavior (Critchfield 1993; Nisbett and Wilson 1977). Therefore, qualitative and quantitative data both must be carefully examined to determine the realms of behavior and context to which they refer. 239
Behavior patterns can be clarified by both quantitative and qualitative approaches. Qualitative approaches can develop an understanding of the meaning and purpose of patterns of behavior and, in combination with quantitative epidemiology and other quantitative approaches, provide an understanding of the behavioral context. Qualitative methods can help define relevant variables, while quantitative methods determine the distribution of the variables. In quantitative methods, patterns are noted and verified by descriptive and inferential statistics; in qualitative methods, data are examined for concurrence of themes and consistency with general propositions or theories. Through developing an appreciation for the broad spectrum of research approaches, it is possible to design studies that effectively lead to an understanding of contextual issues. However, studies should be designed to use complementary approaches from the beginning, rather than trying to add a component when the study is underway. An example of this would be to test an intervention using quantitative analyses of outcomes while ethnographers examine individual and social responses, particularly looking for unanticipated contextual determinants of risk maintenance. Qualitative and quantitative methods should not simply be applied in parallel and independent fashion within a study: they should inform each other. Qualitative data may be analyzed through quantitative methods. A frequent error of quantitative epidemiology, according to the discussion, is to become so far removed from the data collection process that meaning gets distorted in the analyses (e.g., through failure to appreciate the affect in respondents as they selected response options). Further, some data do not lend themselves to quantitative methods for either collection or analysis. THE UNITS OF STUDY AND ANALYSIS MUST BE CAREFULLY SELECTED AND DEFINED CONSISTENT WITH THE RESEARCH HYPOTHESES During the HIV epidemic, there has been a general reluctance to shift from the concept of risk groups to understanding behavioral variation and occurrence at the levels of the individual, dyad, and small group. Studies of patterns of how a disease is spread throughout a population do not sufficiently address the determinants of that spread, such as motivations for engaging in risk behavior, determinants of relapse, and predictors of self-protective behaviors. For example, women are defined and studied 240
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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
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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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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 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: abusers, and other variables are ne
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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The Context of HIV Risk Among Drug Users and Their Sexual Partners

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