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

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The older drug injection literature probably remains relevant for women IDUs with chronic chemical dependency problems. In most of the literature on chemically dependent women, initiation and continued access to drugs occur mainly through male sexual partners (Barnard 1993; Kane 1991; Rosenbaum 1981; Worth 1991), which partially explain the disproportionate percentage of women IDUs who have drug-using sexual partners compared to male IDUs. This is reflected in the HIV risk literature, which shows that women primarily share injection equipment with sexual partners or with close-knit groups that include the sexual partner (Barnard 1993; Kane 1991). These studies indicate that overall rates of needle-sharing may be greater for women compared to men. Injection of drugs with strangers in shooting gallery-type settings or with groups of casual acquaintances with frequent shifts in membership are predominantly male behaviors. In samples of individuals in drug treatment, women have a faster transition from drug use initiation to addiction (Anglin et al. 1987; Hser et al. 1987) and greater severity of addiction as compared to their male counterparts (Anglin et al. 1987; Hser et al. 1987; Rosenbaum 1981). The greater ease of obtaining steady drug money through female prostitution, compared to the more risky and erratic economic activities of IDU males, may be a central factor in these gender differences (Anglin et al. 1987; Hser et al. 1987; Rosenbaum 1981). However, even if the numbers of IDUs were to become equal for males and females, reasons for initiation of drug use, access to needles, and needle use settings are likely to retain strong gender differences as long as gender-based social and economic differences remain among drug users. Illicit drug distribution economies are male-dominated hierarchies, resulting in the restriction of female roles in drug procurement (Naffine 1987). Chemically dependent women tend to have drug-using male sexual partners to overcome gender barriers to drug access. When women decide to seek treatment, however, a drug-using sexual partner may obstruct access to treatment (Mondanaro 1989). For IDU women, drug use by male sexual partners may be the central problem in reduction of high-risk needle use or high-risk sex associated with both injection and noninjection drug use [e.g., crack). The chief implication is that HIV-risk-reduction programs for women who use drugs must consider the continued central role of drug-using male sexual partners. As indicated in Allen’s sampling of the recent HIV literature 43
(this volume), there is little attention paid to the gender-specific contextual issues of injection drug use as outlined above. In her review, O’Leary (this volume) points out that sexual risk reduction programs for women require great sensitivity to problems of male domination of sexual roles. Prevention programs instruct women to require male partners to use condoms. Sexual partners may be longstanding relationships, casual partners, or potential long-term partners who may or may not be willing to comply for different reasons, depending on the nature of the partnership or the individual psychology. Although the majority of males do not respond with hostility to a condom request, some do. Violent assaults on women by male sexual partners, documented for over a century (Gordon 1988), are estimated to occur for as many as 1 in 4 women (Herman 1992). Yet this problem, which exists in all social classes, seldom has been considered formally in risk reduction programs. Women who use illicit psychoactive substances are especially likely to have a childhood history of physical and sexual abuse as well as violent adult sexual partnerships (Boyd 1993). Prevention programs should counsel both men and women to recognize abuse potential and to develop strategies to reduce abusive behavior as part of safer sex awareness and practice. Other points in the O’Leary review bear reiteration. The crisis-driven lifestyle of many urban poor people often results in placing a low priority on safer sex practices (Kalickman et al. 1992). While under studied, stabilization of lifestyle is likely an important factor in risk reduction, Most important is the recommendation that community-based intervention programs can be used to fine-tune HIV prevention messages to their own communities. The advantage of establishing communitybased prevention programs is that new strategies may be tested directly using the images, language, and styles of a community as defined by the community itself. What is missing in the review on sex risk also is missing in the HIV literature in general: focused research on sexual risk behavior and its reduction in different social strata. One suspects there are many commonalities among women in different social strata, but there are no comparative studies. A potential effect of more broad-based research on women’s strategies in practicing safer sex might be to dilute the excessive 44
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 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: transmission from males to females
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
Page 99 and 100:
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
Page 105 and 106:
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
Page 123 and 124:
Trade hustlers are usually heterose
Page 125 and 126:
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.
Page 159 and 160:
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
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AUTHORS Mary Jane Rotheram-Borus, P
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Brunswick goes on to discuss the le
Page 191 and 192:
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
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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
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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
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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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