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

The investigators found that these women did place a high value on
relationships with their men, but they were not submissive, dependent, or
self-sacrificing women as is often portrayed. The investigators found that
condom use was inconsistent in the women’s relationships. Based on
differential perceptions and judgments related to physical discomfort
when using the condoms, HIV status, length and intimacy of the
relationship, perception of the partner’s risk, and personal sense of
responsibility toward the partner, the women determined whether or not
condoms would be used. Although the women believed condom use was
important with casual partners, a majority of the women agreed that use
of condoms with primary partners was not important or desirable. The
reason for this belief was based on showing trust to partners and special
concerns that using condoms would interfere with the romance of the
moment. It seems that most of the issues affecting this major decision
were related to the partner’s feelings or to what was going on in the
relationship. The emphasis on the relationship seems, characteristic of
low to moderate levels of differentiation of self as described by Bowen
(1978). The women who were HIV positive felt it was important to use
condoms with someone they cared about, but they did not feel it
necessary to extend that loyalty and concern to casual partners.
These female subjects reported a number of strategies they used with
good results to insist partners use condoms, which shows that they had
some resources for negotiating safer sex. However, this negotiation
required much effort on their part.
In view of differences in drug usage between Puerto Ricans and other
Hispanic groups (e.g., Puerto Ricans have higher rates of illicit drug use
than Mexican Americans), results from this study should not be
generalized to other groups. Also, these women were from drug
treatment programs, which likely influenced their attitudes and responses.
For a group of women not in treatment, the responses could be different,
especially for that subset of crack-abusing women who work in crack
houses and go from partner to partner for the sake of getting the drug,
securing housing, and so forth.
Kline and colleagues’ data allowed them to examine IVDUs’ condom use
and sexual behaviors. They utilized a family and cultural perspective to
understand factors affecting women’s decisions surrounding condom use.
In addition, they gathered information regarding economics and family
responsibilities that influenced behavior, despite contrary stereotypes of
these women regarding submissive behavior. It is important to put these
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