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

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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? 241
As Des Jarlais noted, designs and analyses must account for the instability within populations. IDUs start and cease injection every day within a given city, so the overall rate of injection can be constant within a city while numerous significant changes in injection behavior are occurring at other levels of analysis. The increase in use of heroin by sniffing or insufflation, for example, represents a significant shift in risk behavior that would not be captured by statistics on heroin use unless heroin use were disaggregated by route of administration. Drug abuse itself is a chronic disorder with a varying course over time, and variations in the disease course may be associated with risk behaviors and related cognitions, motivations, and appraisals. Factors that account for changes within a population must be studied to truly understand behavior. CULTURAL DIFFERENCES ARE NOT SUFFICIENT EXPLANATIONS OF THE CONTEXT OF RISK BEHAVIOR Culture is a concept that must be treated with respect because it refers to exceedingly complex issues that have significant impacts on behavior. Cultural variables may include observable phenomena such as family composition and types of buildings as well as elements not directly observable such as national identification, religious beliefs, and affective style. As an example of the complexity of culture, when one considers the diverse countries of origin, the range of socioeconomic resources, the linguistic differences, and the geographic dispersion represented in groups that all legitimately may be called Hispanic, the term “Hispanic culture” has no clear and unitary meaning. Even if its meaning were clear, how would one tease apart the contributions of Hispanic culture and U.S. culture? In drug-using populations there are norms that may constitute a drug culture that overlies and interacts with other cultural variables. This drug culture is not homogeneous across groups. Drug norms themselves shift, as the growing acceptance by drug sellers of marketing to young adolescents demonstrates. It is clear that norms and values of different subpopulations affect each other, and conceptualization of research issues must take this into account. One example cited in the review of one norm influencing another was how adolescents’ ideas about sexual identity are influenced by larger societal attitudes towards sexual functioning. Research designs that compare one cultural group with another often lead to conceptual dichotomization of continuous traits, so that it becomes 242
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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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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 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 and 244: abusers, and other variables are ne
Page 245: Behavior patterns can be clarified
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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