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

strengths within a setting or individual, as these are often not specified a
priori in designing studies.
Individuals and communities have made changes in risk behavior
patterns. Better understanding of how these changes have developed is
needed, and an understanding of discrepant norms is needed. An
example given is that one norm promoted by HIV prevention programs is
“a man is not supposed to bring a disease home,” yet these programs also
promote that “a woman is not supposed to trust a man to protect her.”
What are the positive and negative ramifications for the individuals and
the relationships from such discrepant messages?
ALTHOUGH FURTHER UNDERSTANDING OF CONTEXTUAL
ISSUES IS NEEDED, IT IS ALREADY CLEAR THAT
FUNDAMENTAL CHANGES IN PEOPLE’S LIVES WILL BE
REQUIRED TO ADDRESS HIV RISK
High rates of homelessness, unemployment, and general economic
disadvantage have been found in studies of drug users and their sexual
partners at risk for HIV infection (Brown and Beschner 1993), although
the severity of these social and environmental problems differs with
geographic region. Dr. Gibson (this volume) and others (Malow et al.
1992) noted an association of depression and anxiety with HIV risk. It is
likely that social and intrapersonal factors not only affect risk behaviors,
but that they interact to determine risk.
Because of this interaction, and without denying the enormous impact of
social problems, changes in social environments alone are not likely to
reduce all risk. For example, poverty is associated with HIV risk.
However, Dr. Robles noted that in Puerto Rico, women may have
resources such as an apartment and income, yet repeatedly become
involved with one IDU boyfriend after another. Clearly, lack of
economic empowerment, which the women have at levels necessary for
self-sustainment, does not explain the self-defeating pattern.
Companionship, prestige, and other psychological factors need to be
examined, and fundamental changes in people’s cognitions, attitudes, and
feelings about themselves may be required for long-term risk reduction.
Research must take into account the interaction of social and other
environmental factors and psychological factors in the development of
risk behaviors, and fundamental changes in both spheres will be needed
to sustain health protective behaviors.
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