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

as a population, and discussions of women’s risk often center around
their roles in the family, the community, and peer groups. These roles
raise questions about the appropriate unit of study and analysis for
research on women.
Similar issues about unit of analysis also apply to other populations.
Should studies be designed and analyzed on the level of the individual,
the community, the family, or the sexually active couple? Such questions
have profound implications for the design, statistical analysis, and cost of
investigations, and the answers must derive from the hypotheses of the
study. It makes little sense, for example, to study empowerment in
women without examining other people in the woman’s life, as
empowerment implies an interpersonal dynamic as well as an
intrapersonal change.
A helpful way to think about units of analysis is to think in terms of
systems elements that must be understood and affected in a risk-reduction
program. For example, Dr. Robles noted that Puerto Rican IDUs were
unlike the typical IDU in the continental United States in that they tend to
live with families. The families do not generally allow injection in the
home, so a number of elements must be linked for the IDU to use drugs.
The family, the shooting gallery, and sometimes houses of prostitution
constitute linked elements where greater understanding is needed and
interventions might occur. In other settings, families may not be as
important; elements such as peer networks and separate sexual networks
may need to be addressed instead. Disparate settings provide an
opportunity for examining microstructural issues, such as how a crack
house serves as an economic institution, in relationship to broader
macrostructures (e.g., community economic distress).
Analyzing data at a community or population level is often necessary, but
it is fraught with complexities. Populations overlap and do not neatly fit
usual research definitions. For example, the overlap of men who have
sex with men and IDUs may serve as a bridge to HIV transmission if an
infected IDU has sex with a uninfected man. But are the men who are in
both groups and who constitute the points of overlap best understood as
drug users, as gay men, as non-gay-identified men who engage in
homosexual activity, or as a unique group? Is the unit of analysis the
man within the group? If one designs a community intervention for this
group, would it look more like an intervention for IDUs or for men who
have sex with men, or would it be notably unique?
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