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

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equipment; instead, they are being shared for them. Having a low level of differentiation of self would make the women unable to say “I want this to stop.” Another finding of Harris and colleagues’ study is that even though the intervention is not targeting drug use, drug use is repeatedly mentioned by the female IDUs. Although these women are on a methadone program, they are using drugs such as alcohol, marijuana, cocaine, and heroin. The investigators have learned that addressing HIV transmission among this population without addressing the issue of drug abuse is not approaching the problem from a comprehensive perspective. Frischer and colleagues (1993) reported on their study conducted in Scotland that aimed at theoretically modeling the behavior and attributes of intravenous drug users (IVDUs) in order to examine relationships between different variables as they affect HIV risk practices. In face-to-face interviews, the investigators administered a questionnaire that captured 10 variables: treatment, drug use, needle sharing, harm reduction, prison, prostitution, income, travel, sex, and AIDS awareness. This questionnaire was designed by an international World Health Organization (WHO) working party and used in 11 cities worldwide. The investigators used the questionnaire to collect data from 503 drug-using subjects and submit it to the linear structural relations program (LISREL). Data were collected in an attempt to establish relationships predictive of HIV risk, HIV harm reduction, or protection from risk. Although the authors reported no specifics regarding the percentage of female subjects, data were analyzed in order to determine if gender contributed to the predictive power of equations addressing HIV risk. In terms of HIV risk for female IVDUs, it was found that higher levels of drug use were associated with higher levels of sexual activity and with lower levels of precautions taken in relation to HIV. Injecting drug use was related to sharing of injecting equipment; those who injected more also shared more. Female subjects, particularly younger females, those reporting higher levels of drug use, and those reporting higher levels of sexual activity, reported higher levels of sharing injection equipment than males. Injection drug use was found to be a predictor of prostitution. High levels of drug use were associated with prostitution and illegal behavior for obtaining drugs, Another predictor of sharing injection equipment 53
found in this study was low socioeconomic status; those at the lower end of the socioeconomic scale and those needing housing engaged in more sharing. Drug use was the best predictor of harm reduction in that those who reported a low level of drug use engaged in high levels of harm reduction and vice versa. In other words, a low incidence of drug use was a protective factor against HIV transmission risk for the women in this study. AIDS awareness was related to harm reduction. Female drug users living with their sexual partners and having stable housing and living arrangements reported high levels of AIDS awareness and were less likely to engage in risky sexual behaviors. Another protective factor discovered was that of treatment for drug abuse in that it engendered safer practices both with regard to sexual activity and drugs. The lack of reporting the exact number of women subjects in the study leaves an opening for challenging gender-specific results. Also, the reporting could have been strengthened by providing more details on the reliability and validity of the data collection instrument. However, the study demonstrated the utility of applying statistical models and analyses through LISREL to identify variables contributing to risk of HIV transmission among female drug users. An important finding in this study is the impact of drug abuse treatment on high-risk behaviors. Researchers found that treatment engendered safer practices with regard to sexual activity and drugs. More treatment was reported by older female IVDUs and those cohabiting with sexual partners. This study by Frischer and colleagues (1993) revealed behaviors and attributes that contribute to high-risk behaviors for HIV transmission and provided some information about the context in which such behaviors occur. Kang and De Leon (1993) reported on a study of correlates of drug injection among 152 methadone outpatients; 39 percent (59) of the subjects were female. Data were gathered on sociodemographic background, drug use and treatment history, needle use behavior, sexual behavior, medical status, criminal history, and psychiatric/psychological status. Correlation coefficients were used to examine relationships between variables, and discriminant analysis was used to explore predictors of classification of high- or low-risk behaviors. High levels of 54
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National Institute on Drug Abuse RE
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ACKNOWLEDGMENT This monograph is ba
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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 and 56: have the data but interpret it supe
Page 57: important to examine current studie
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
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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
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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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