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

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inge on crack for days at a time, neglecting food, sleep, and basic hygiene, severely compromises physical health. Consequently, crack users appear emaciated most of the time. They lose interest in their physical appearance. Many have scabs on their faces, arms, and legs-the result of burns and picking at the skin to remove bugs and other insects believed to be crawling under the skin. Crack users tend to have burned facial hair from carelessly lighting their smoking paraphernalia, they have mouth ulcerations and burned lips and tongues from the hot stems of their pipes, and they seem to cough constantly. In addition, many have self-reported and have been observed to have untreated STDs (Inciardi et al. 1993; McCoy and Miles 1992; Ratner 1993). Going further, although street prostitutes who barter sex for money to purchase drugs often insist that their customers use condoms, this is not usually the case with crack house sex. In fact, condoms are rarely seen in crack houses. Given the health status of crack users (including a high likelihood of compromised immune systems), the incidence of STDs (many of which go untreated), and general lack of condom use, many of the conditions that have contributed to the heterosexual transmission of HIV in Africa exist in crack houses in Miami, New York, Philadelphia, and other urban areas across the United States. In addition, given the frequency of sex and the large number of partners associated with crack house sex, the potential for coming into contact with HIV is of an even greater magnitude. And it is within this context that the heterosexual transmission of HIV to non-IDUs is most likely. Furthermore, there are a number of situations that may make the crack house unique in the heterosexual spread of HIV. In a study of crack house sexual activities in Miami, for example, a number of men reported that they could climax only through extremely vigorous masturbation or prolonged vaginal intercourse. Many of the female partners in these exchanges reported that the lengthy intercourse resulted in both vaginal and penile bleeding (Inciardi et al. 1993). In situations as these, the potential for female-to-male transmission of HIV increases. During vaginal intercourse, the friction of the penis against the clitoris, labia minora, and vaginal vestibule, opening, and canal causes stimulation that can generate copious amounts of vaginal secretions. And as noted above, HIV has been isolated from vaginal/cervical secretions. Moreover, since women who exchange sex for crack in crack houses do so with many different men during the course of a day or night, potentially HIV-infected semen from a previous customer can still be present in the vagina. It was reported by one crack house customer that he had ruptured 33
the skin on his penis while having intercourse with a crack house prostitute while she was menstruating. This informant also indicated that vaginal sex during menses was not a rare event. As such, genital secretions as well as semen and blood come into direct contact with the traumatized skin of a client’s penis during crack house sex. In many crack houses, it is not uncommon for women to engage in repeated oral, vaginal, and anal sexual activities, often with no time lapse between successive customers. Since condom use is rare, not only are the women exposed to the semen of all of their male partners, but successive male partners also are exposed to the semen of the women’s previous partners (Inciardi et al. 1992). As such, heterosexual transmission of HIV can be from male to female, female to male, and male to male. It would appear, moreover, that this phenomenon is not unique to crack house sex. In an Orange County, California, study of Hispanic undocumented migrant workers and heroin-addicted prostitutes (Magana 1991), a parallel situation was found. Large numbers of men engaged in vaginal intercourse with the same woman in rapid succession-a sexual behavior referred to by the participants as becoming “milk brothers.” Finally, there is the matter of oral sex. Few studies have associated orogenital sex with HIV transmission (Fischl et al. 1987; Puro et al. 1991), and the majority of reports have examined this transmission route among homosexual men (Keet et al. 1992; Lifson et al. 1990; Rozenbaum et al. 1988). Only one fully documented case of female-to-male transmission through oral sex has appeared in the literature (Spitzer and Weiner 1989). In crack houses, oral sex (both fellatio and cunnilingus) is common. Given such risk factors and cofactors as STD infections, genital ulcers, lesions on the lips and tongue, and abrasions on the penis and in the vagina among those who exchange sex for crack, the potential for female-to-male transmission of HIV through oral sex is not inconsiderable. CONCLUSIONS As is apparent from this review, any examination of HIV risks among heterosexual male non-IDUs must be done primarily through indirect evidence. At present, the number of confirmed cases of female-to-male AIDS cases in the United States is comparatively small, and the majority of studies of drug-using groups find that most subjects have multiple risk 34
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 and 34: during that time, and the possibili
Page 35 and 36: All of these issues and considerati
Page 37: ecoming the norm for both male and
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
Page 93 and 94:
Substance Use and HIV-Transmitting
Page 95 and 96:
TABLE 1. Prevalence of substance us
Page 97 and 98:
less than 2 percent of participants
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TABLE 2. Quantity of alcohol use am
Page 101 and 102:
A fourth study of gay/bisexual men,
Page 103 and 104:
in mind, however, that most of the
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seropositivity and reported NMPD us
Page 107 and 108:
interaction and education than men
Page 109 and 110:
Geographic differences found in the
Page 111 and 112:
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
Page 121 and 122:
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
Page 129 and 130:
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
Page 145 and 146:
Although these data provide an over
Page 147 and 148:
Most of these were unprotected sexu
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national epidemiologic survey of hi
Page 151 and 152:
Hawkins et al. 1992; Newcomb et al.
Page 153 and 154:
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
Page 185 and 186:
Jessor, R., and Jessor, S.L. Proble
Page 187 and 188:
AUTHORS Mary Jane Rotheram-Borus, P
Page 189 and 190:
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
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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
Page 205 and 206:
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
Page 213 and 214:
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
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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
Page 241 and 242:
Future Directions for Studies on th
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abusers, and other variables are ne
Page 245 and 246:
Behavior patterns can be clarified
Page 247 and 248:
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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