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

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.
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