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

sharing? When are needles deliberately shared with others versus used in
unknown contexts such as in shooting galleries? Why do IDUs share
needles? What is the role of the heterosexual IDU partner? Does
sharing/not sharing affect the relationship? What factors are associated
with situational variation in behaviors? What is the composition of a
needle-sharing network?
Further efforts should be focused on the factors that predict persistent
high risk. Under what circumstances do low-risk individuals move to
high risk? In the context of simultaneous risks, how is the hierarchy of
risks constructed and how does it impact the decision to share needles and
other injection equipment?
Contextual and social network variables should be examined using
intensive ethnographic observation and in-depth interviewing. The
unique aspects of heterosexual relationships (steady partnership, multiple
partnership, cultural values, family values, smooth social relations) need
to be examined in the context of IDU network relationships such as those
to running buddies. AIDS often does not pose an immediate risk;
however, the introduction and use of condoms, or the suggestion of
cleaning needles shared with a sexual partner, may pose an immediate
interpersonal risk.
Research on HIV transmission from IDUs to non-IDU sexual partners is
today the subject of increased attention due to the confirmed risk of
heterosexual transmission. However, the importance of HIV transmission
among IDUs who engage in sexual relations with other IDUs should not
be ignored. Heterosexual IDUs should be alerted not only to the risk of
sexual HIV transmission to their non-IDU sexual partners but also to the
risks of contracting and transmitting HIV through heterosexual
intercourse with other IDUs.
Intervention efforts may need more realistic goals. Changing HIV risk
behavior is complex since these risk behaviors are based on interpersonal
relations. Further efforts need to be directed at how risk behaviors vary
across sexual orientation (homosexual, bisexual, and heterosexual) and
whether factors that appear to be related to relapse to risk behaviors in
homosexual men are similar for bisexual and heterosexual men. Which
components of interventions are most likely to lead to risk reductions?
Under what legal codes is change in risk accomplished; for example, do
researchers need additional studies of the impact of needle exchange
programs?
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