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

Robles and colleagues (1990) examined social relations and roles of 160
Puerto Rican sexual partners of IVDUs in Puerto Rico as they related to
prevention of HIV transmission, particularly use of condoms. They used
the AIDS Initial Assessment instrument developed by the National
Institute on Drug Abuse along with participant observation notes and
transcribed conversations. Although the women were not IDUs, they
engaged in substantial use of noninjected substances. Alcohol was the
most commonly used substance of abuse and marijuana the second most
common. Involvement with noninjection cocaine also was high.
The reasons most cited by the women for not using condoms were that
their husbands did not like it (52.6 percent), and they themselves did not
like the condoms (35.5 percent). Also, 50.3 percent reported other
reasons related to their partners. The article indicated that these women
were cognizant of their risk of getting infected with AIDS, as 84 percent
reported that they had at least some chance of developing AIDS.
These investigators obtained additional contextual information. The
ethnographic data showed that these women did not belong to or
participate in organizational activities. However, they were actively
involved in primary group relationships with family, friends, neighbors,
and peers-particularly family. In applying Bowen’s (1978) ideas, these
women in Puerto Rico would be described as expending much of their
life energy for maintaining relationship systems around them, and there
appears to be little energy left for involvement in other things. There is
no sense of solid self as described by Bowen, to the extent that energy
can be reserved and used for making decisions and changing behaviors
that impact in a major way on their health.
While all of these studies reporting associations between demographics
and specific risk behaviors or between specific drugs and risk behaviors
provide findings that are factual and informative, contextual issues are
relatively neglected. An exception to this is investigation of the impact of
multiple drug use on sexual and injecting risk behaviors. If more
investigators had probed the circumstances or situations that led these
women to use crack as opposed to another type of drug, the impact of
community and family relations on their drug use, or other situationspecific
variables, a fuller sense of the context of the high-risk practices
of women would have been developed. Of particular concern is that
sometimes findings specific to females, and perhaps even females within
specified ethnic groups, could have been reported but were not.
Examples of not reporting analyses specific to females and of neglecting
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