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

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Patient: “Why should it? It’s just one more negative problem to add to the others. Things are already bad, this is not going to make it much worse!” These dialogs put faces behind reported statistics. As of December 1992, among women ages 15 to 24, 912 deaths from acquired immunodeficiency syndrome (AIDS) had been reported to the Centers for Disease Control and Prevention (CDC). Among those 25 to 34 years of age, 7,346 deaths from AIDS had been reported; for women in age groups 35 to 44, 45 to 54, and those 55 years or older, reported deaths from AIDS were 5,924, 1,728, and 1,556, respectively. These numbers represent increases in AIDS death rates across all age categories for women (Centers for Disease Control and Prevention 1993a). CDC (1993b) has described a number of characteristics associated with females with the highest incidence of AIDS. These characteristics included being of African-American or Hispanic heritage, current or past injection drug use, being a non-IDU, and engaging in high-risk sexual activity with IDUs or other HIV-infected persons. In addition, women with AIDS tend to be poor and of disadvantaged socioeconomic status (Ickovics and Rodin 1992). Injecting drugs and having sex without condoms are the two primary behaviors that researchers have focused on and described as being high risk in the transmission of HIV among female drug abusers. Much of what is known about injecting drug use and unsafe sex as related to HIV transmission among female drug users is descriptive epidemiology. When designing and analyzing studies, many researchers report information that describes how many women were exposed through specified behaviors, their levels of knowledge about the disease, or whether certain interventions changed the number of high-risk behaviors. However, there is a lack of information regarding the underlying factors or contextual issues that contribute to drug-using women’s exposing themselves to HIV. Information regarding the emotional, psychological, familial, and social-environmental contexts in which HIV transmission behaviors take place would yield data that would give insight into the motivations for continued behavior. As a result, the data would provide direction for developing effective interventions for decreasing risk behaviors. Some researchers have access to subjects to ask for this type of data, but their research questions do not focus on contextual issues. Some may 49
have the data but interpret it superficially or not at all. The purpose of this chapter is to report on representative current research to determine how well studies have addressed the underlying issues or context in which women, especially African-American and Hispanic women, continue to participate in high-risk behaviors. THEORETICAL PERSPECTIVE A number of theoretical perspectives may be applied to understanding the context of HIV risk in a given population. While certainly not the only applicable perspective, one useful framework that may be applied is the Bowen Family Systems Theory (Bowen 1978). This theory is based on the concept of differentiation of self. The characteristics of women most frequently diagnosed with AIDS, as profiled by CDC, are consistent with descriptions of persons with low to moderate levels of differentiation of self in the Bowen Family Systems Theory. Differentiation of self refers to the degree to which a person has a “solid self” or solidly held principles by which they live. Papero (1990) believes that to the degree that one can thoughtfully guide personal behavior in accordance with well-defined principles in spite of intense anxiety, that person displays a level of differentiation. In addition, Papero (1990) states that the basic level of differentiation of self is manifested in the degree to which an individual manages across life to keep thinking and emotional systems separate, to retain choice between behavior governed by thinking and behavior governed by emotional reactivity, and to set a life course based on carefully thought out principles and goals. The basic level of differentiation of self for any person is believed to develop and become fixed early in life and is usually similar to that of the person’s parents. It is a product of the generations of the persons who raised the individual (the nuclear family) in that each nuclear family embodies the emotional processes and patterns of the generations that have preceded it. A lifestyle of behavior based on thinking or behavior based on emotional reactivity that a child learns from the nuclear family or caregiver is replicated in future relationships (Bowen 1978; Papero 1990). Bowen (1978) described those with low levels of self-differentiation as living in a world where feelings and subjectivity are dominant over 50
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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 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: Female Drug Abusers and the Context
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
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seropositivity and reported NMPD us
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interaction and education than men
Page 109 and 110:
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
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REFERENCES Calzavara, L.M.; Coates,
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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
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Boyer, C.B. Psychosocial, behaviora
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Irwin, C.E., Jr., and Shafer, M.A.
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Zweig Greenberg, MS.; Singh, T.; Ht
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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
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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
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REFERENCES Agar, M. The Professiona
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Ouellet, L. J.; Jimenez, A.D.; John
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Assessing the Reliability and Valid
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TABLE 1. Sociodemographic profile o
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Table 2 shows percentage agreement
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FORENSIC TECHNIQUES TO DOCUMENT SEL
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cross-tabulated with dichotomous me
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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
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127 PROGRESS AND ISSUES IN CASE MAN
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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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