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

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objective reasoning. Persons with low levels of self-differentiation are further described as dependent on the feelings of those around them, expending so much of their energy in maintaining the relationship system about them (loving, being loved, reacting against failure to get love, and achieving comfort from anxiety) that there is no life energy left for other things. Another characteristic is that major life decisions are made on the basis of what “feels right” or simply on being comfortable. Persons with low levels of self-differentiation not only do not use the “differentiated I” in relationships with others, they are incapable of doing so. Further, they inherit a major portion of the world’s serious health, financial, and social problems. Bowen described persons with moderate levels of differentiation of self as being overtly emotionally dependent on others and in lifelong pursuit of the “ideal close relationship.” If they fail to achieve it (a likely probability), they may withdraw, become depressed, or pursue closeness in another relationship. Those with moderate levels of self-differentiation are recipients of a high percentage of human problems, including the full range of physical illness, emotional illness, and social dysfunctions marked by many levels of impulsive and irresponsible behavior. Finally, they tend to be involved in the use and abuse of substances to relieve the anxiety of the moment. Bowen then described the level of self-differentiation that he believed contributed to good health and should be promoted among clients and their families. Those characterized as having healthy and good levels of self-differentiation have an intellectual system that is sufficiently developed to begin making a few decisions without the emotional system, and they have developed a reasonable level of solid self on most of the essential issues in life. They are able to successfully meet new situations and, while aware of the importance of relationships in life, determine their life course from within themselves rather than from what others think. Such persons are able to cope successfully with a broad range of human situations and are remarkably free from the full range of human problems. Bowen’s system is subject to the criticisms of other motivational or psychodynamic theories (e.g., difficulties in operationalizing constructs, observed outcomes not uniquely predicted by theory), but it does provide a context for understanding behavior and a method of integrating observed behavior with potential meaning of that behavior. It is 51
important to examine current studies to see if this or similar theoretical bases are being used or could be used to guide and interpret extant research. REVIEW OF CURRENT RESEARCH One example is the research currently being conducted at the University of Maryland School of Nursing. This study is aimed at reducing the high-risk behaviors of needle sharing and sex without condoms among African-American female IDUs. It is a 3-year experimental design study targeted for 200 subjects in a methadone maintenance program. The study is called the Peer Counseling and Leadership Training (PCLT) program, and it focuses on control and self-esteem as critical issues in development of efficacious selves, sex and sexuality as related to AIDS, and self-reported lifestyles that have implications for drug use and sexual behaviors. The goal of this intervention is empowerment through instillation of a sense of inner control and motivation based on increased self-esteem and competency involving self, relationships with others, and involvement with the community. Particular attention is paid to sensitivity to and management of relationships with others and to attitudes involving trust, competence, confidence, positive thinking, personal direction, and self-identity (R.M. Harris, personal communication, March 18, 1993). This research does appear to be addressing some of the contextual issues of HIV transmission among female drug abusers. The activities in the intervention are consistent with the Bowen Family Systems Theory and could be seen as helping women develop a solid self as well as appealing to their intellect for increasing their ability to determine their behavior based on thinking rather than emotional reactivity. It could be argued that the effect of the intervention is to change a major factor in behavior, low level of differentiation of self. However, because the researchers are not viewing the subjects’ self as having developed as a result of embodying emotional processes and patterns of previous generations, the expectation is that intended changes resulting from the intervention will happen soon. Bowen (1978) states that an increase in the level of differentiation of self is gradual and takes a while to accomplish. According to Harris, one initial finding from this study is that the partners of female drug users lend the women’s equipment to other IDUs. Hence, some female drug users are not necessarily sharing their needles and 52
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 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: have the data but interpret it supe
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
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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,
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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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