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

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In 1992, at the National Insitute on Drug Abuse (NIDA) AIDS research planning meeting, Dr. Cohen reiterated her argument: Direct information on customers becoming infected by sex workers is very limited, but does not support more than rare instances of transmission. CDC data report very low rates of “heterosexual transmission” or “no identified risk” AIDS cases among men; given the number of men who purchase sex in this country, these low rates argue against anything but rare transmission. (p. 1) As already noted, in Africa, by contrast, there is considerable evidence of viral transmission by HIV-infected prostitutes to their male customers (Barnett and Blaikie 1992; Carswell et al. 1989; Shannon et al. 1991). A number of factors contribute to this difference. Among African prostitutes and their customers, there appear to be significant proportions with untreated STDs, including genital ulcers, and these appear to increase men’s susceptibility to HIV (Cameron et al. 1987; Johnson and Laga 1988; Kreiss et al. 1989; O’Farrell 1989; Piot et al. 1987; Plummer et al. 1991; Simonsen et al. 1988). In addition, several studies have noted that sex workers in the United States are more conscious of STDs and are more likely to use safer sexual practices (e.g., vaginal and anal sex with condoms) with customers than those in Africa (Cohen 1992). For example, a number of reports have noted that there is a socialization process associated with becoming a prostitute in the United States. Would-be and neophyte prostitutes learn the appropriate techniques and safeguards through apprenticeships with pimps or more experienced prostitutes (Carmen and Moody 1985; Evans 1979; Goldstein 1979; Miller 1986; Rosenbaum 1981; Winick and Kinsie 1971). In some cases there is informal or even formal training on how to protect oneself from theft, violence, or disease. For example, in one sociological analysis of prostitution as an occupation, it was found that the recognition of STDs was a specific topic of instruction for neophyte house prostitutes (Heyl 1979). Furthermore, those who work the streets or in organized houses of prostitution in the United States have friendships and peer relationships, however loose, unstructured, and transitory they may often be, through which experiences are shared, techniques are traded, warnings are communicated, and knowledge is reinforced. 29
All of these issues and considerations have relevance to the examination of HIV risks among heterosexual male non-IDUs who exchange crack for sex. THE BARTERING OF SEX FOR CRACK COCAINE Although the bartering of sex for crack had been mentioned in the popular media at the very beginnings of the crack epidemic (Gross 1985; Lamar 1986; Lawlor 1986), the first empirical study of the phenomenon did not appear in the scientific literature until 1989. In that analysis, drawn from a larger study of drug use and street crime among serious delinquents in Miami, the potential for HIV acquisition and transmission through sex-for-crack exchanges was addressed (Inciardi 1989). Of 100 girls in the 14- to l7-year age range, 27 had bartered sex for crack during the 1-year period prior to interview. Of these, 11 had traded sex for drugs on fewer than 6 occasions but had nevertheless exchanged sex for money on an aggregate of 6,850 occasions. By contrast, there were others in the sample who had bartered sex hundreds and even thousands of times. At about the same time that this research was being reported, others began to notice rising rates of syphilis and other STDs among crack users (Bowser 1989; Fullilove and Fullilove 1989; Fullilove et al. 1990; Kerr 1989; Knopf 1989a, b). Shortly thereafter, sex-for-crack exchanges were targeted for systematic study, but to date, only a few reports have appeared in the literature. Moreover, one of the difficulties in assessing the nature of HIV risks associated with crack use, particularly among heterosexual male non-IDUs, is the fact that most crack users engage in multiple risk behaviors. A study of risk factors for HIV-1 infection was conducted at an STD clinic in an area in New York City where the cumulative incidence of AIDS in adults through mid-1990 was 9.1 per 1,000 population and where the use of illicit drugs, including crack smoking, was common (Chiasson et al. 1991). The overall seroprevalenee among the 3,084 volunteer subjects was 12 percent, with 80 percent of these seropositives reporting risk behaviors associated with HIV-1 infection, including maleto-male sexual contact, IV drug use, and heterosexual contact with an IDU. The seroprevalence in individuals denying these risks was 3.6 percent in men (50 of 1,389) and 4.2 percent in women (22 of 522). Among these individuals, the behaviors associated with infection were 30
Page 1 and 2: National Institute on Drug Abuse RE
Page 3 and 4: ACKNOWLEDGMENT This monograph is ba
Page 5 and 6: Drug Use and HIV Risk Among Male Se
Page 7 and 8: Partners. The review was held April
Page 9 and 10: Inciardi, J.A.; Lockwood, D.; and P
Page 11 and 12: highlights the critical importance
Page 13 and 14: AUTHOR Richard H. Needle, Ph.D., M.
Page 15 and 16: Blower and colleagues (1991) have p
Page 17 and 18: Even in areas with low seroprevalen
Page 19 and 20: involves using a syringe to draw bl
Page 21 and 22: Hispanics were less likely to repor
Page 23 and 24: victimization through theft, violen
Page 25 and 26: sharing? When are needles deliberat
Page 27 and 28: Chitwood, D.D.; McCoy, C.B.; Inciar
Page 29 and 30: Page, J.B.; Smith, P.C.; and Kane,
Page 31 and 32: HIV/AIDS Risks Among Male, Heterose
Page 33: during that time, and the possibili
Page 37 and 38: ecoming the norm for both male and
Page 39 and 40: the skin on his penis while having
Page 41 and 42: REFERENCES Ball, J.C., and Chambers
Page 43 and 44: Johnson, A.M.; Petherick, A.; David
Page 45 and 46: Vogt, M.W.; Craven, D.E.; Crawford,
Page 47 and 48: transmission from males to females
Page 49 and 50: (this volume), there is little atte
Page 51 and 52: Clayton, R.; Voss, H.; Robbins, C.;
Page 53 and 54: Female Drug Abusers and the Context
Page 55 and 56: have the data but interpret it supe
Page 57 and 58: important to examine current studie
Page 59 and 60: found in this study was low socioec
Page 61 and 62: who trade sex for crack; and simila
Page 63 and 64: esponsibilities in perspective. Suc
Page 65 and 66: Robles and colleagues (1990) examin
Page 67 and 68: The lack of rational thought separa
Page 69 and 70: Factors Associated With Sexual Risk
Page 71 and 72: Factors Associated With Poverty A n
Page 73 and 74: encouraging such women to leave the
Page 75 and 76: Hispanic women but extramarital aff
Page 77 and 78: coherence—the sense that life is
Page 79 and 80: the change agent may be a crucial f
Page 81 and 82: Centers for Disease Control and Pre
Page 83 and 84: Jemmott, J.B.; Jemmott, L.S.; Spear
Page 85 and 86:
O’Leary, A.; Celentano, D.; Maiba
Page 87 and 88:
Drug Use and HIV Risk Among Gay and
Page 89 and 90:
with 34.6 percent of gay men and 28
Page 91 and 92:
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
Page 115 and 116:
REFERENCES Calzavara, L.M.; Coates,
Page 117 and 118:
Ostrow, D.G.; Beltran, E.; Chmiel,
Page 119 and 120:
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
Page 155 and 156:
Boyer, C.B. Psychosocial, behaviora
Page 157 and 158:
Irwin, C.E., Jr., and Shafer, M.A.
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Zweig Greenberg, MS.; Singh, T.; Ht
Page 161 and 162:
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
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TABLE 1. Ecological paradigm of con
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TECHNICAL ISSUES Technical issues i
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eliability. It seems obvious that q
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sometimes as many as three zip code
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Resources and effort are required t
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Brunswick, A.F.; Lewis, C.S.; and M
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The Context of Risk: Ethnographic C
Page 209 and 210:
same meaning may be extended to dru
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THE CONTEXT OF RISK Context is an a
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hurried, and adequate needle cleani
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degrading sexual acts, poignantly m
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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
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aggravate self-presentation bias. T
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TABLE 8. Percent of subjects report
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intercourse, and since anal interco
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Future Directions for Studies on th
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abusers, and other variables are ne
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Behavior patterns can be clarified
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As Des Jarlais noted, designs and a
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strengths within a setting or indiv
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National Institute on While limited
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62 NEUROSCIENCE METHODS IN DRUG ABU
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89 BIOLOGICAL VULNERABILITY TO DRUG
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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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