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

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symptomatic distress, depression, and anxiety among the 59 female IVDUs were reported. In an analysis of data from the Australian National AIDS and Injecting Drug User Study, Darke and colleagues (1992) examined the context of benzodiazepine use among IVDUs and its impact on HIV transmission risk behaviors. The study was conducted in Australia, but the research questions investigated have implications for female IDUs in the United States. Two questions are particularly relevant: “What is the prevalence of benzodiazepine use in this population?” and “Does use of this drug cause this population to engage in more risky injecting and sexual behavior?” Out of the 1,245 IVDUs, 331 were females. The interview schedule used had been pilot tested and contained sections on demographics; drug treatment and incarceration history; drug use including type of drug used, frequency, and method of use; patterns of needle use and reuse; social context of injecting drug use; sexual history; knowledge of and attitudes towards HIV; and behavior change in response to HIV. Results showed that female IVDUs were more likely than males to report benzodiazepine use. In turn, benzodiazepine users reported younger mean ages at first injecting use and at first regular injection drug use than did the rest of the sample. The benzodiazepine users also reported significantly more injections during the last month of use, more injections of heroin, and greater frequency of injections with borrowed equipment. The benzodiazepine users were more likely to have engaged in prostitution. Other information that became clear with this study is that many risk behaviors took place in the context of multiple drug use. It seems likely that unless use and abuse of mood-altering drugs among these females are addressed comprehensively in conjunction with contributing contextual issues, HIV transmission risk behaviors will stay the same or increase. Forney and colleagues (1992) conducted interviews with 60 female drug users: 25 in rural Georgia and 35 in the inner city of Miami. The women were approached through street outreach workers and contacts with local public health and drug treatment centers. The purpose of the study was to determine the sociodemographics of women who exchange sex for crack cocaine; the drug use and sexual histories of these women; knowledge, beliefs, and attitudes about AIDS and HIV transmission among women 55
who trade sex for crack; and similarities and differences in sexual practices of rural and urban female crack users. Of the 35 subjects from Miami, 24 were African American, 7 were white, 3 were Hispanic, and 1 was Asian American. Of the 25 subjects from Georgia, 21 were African American, and 4 were white. The primary source of income was prostitution for 63 percent of the Miami sample and for 68 percent of the Georgia sample. Except for alcohol and marijuana use, crack cocaine was used more regularly than any other drug, and respondents in both Miami and Georgia received their crack through barter systems. In these systems, crack is purchased in a variety of ways, including money from drug sales, bonuses for selling drugs, in exchange for stolen goods, in exchange for other drugs, and as pay for sex. Occasionally, the drugs were simply given to the women. For both samples, the most common means of obtaining crack was in exchange for sex (65 percent in Miami, 72 percent in Georgia). Forney and colleagues reported that almost all of the respondents expressed concern about AIDS and seemed to understand HIV transmission routes; however, few had changed behaviors to reduce their risk for HIV infection except initiating or increasing condom use. Most continued to engage in high-risk practices, particularly unsafe sex with numerous partners, in an effort to support their chronic crack habits. This study provides useful details and speaks to the powerful influence of physiological addiction in maintaining risky behaviors. Future studies should attempt to address other factors in the lives of female drug users to clarify what life events and circumstances necessitate their continuing to risk their lives to obtain drugs. What contextual issues present in their lives drive them to high-risk sexual practices to achieve and continue their high? In focus groups with 134 African-American and Hispanic IVDUs and HIV-positive women, Kline and colleagues (1992) explored attitudes and behaviors that surround sexual decisionmaking in minority communities. Approximately 85 percent of the Hispanic participants were Puerto Rican, and 9 percent were Cuban. Forty-five percent of the entire group of Hispanic women were born outside of the United States. Moderators of the focus groups were provided with discussion guides containing a set of 35 to 40 core questions that all groups were asked and 10 to 15 additional questions specific to the category of risk. 56
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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
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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 and 58: important to examine current studie
Page 59: found in this study was low socioec
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
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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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