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

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contextual issues despite an apparent availability of some relevant data are not unique. The author wishes to emphasize that results specific to female subjects are needed and important. CONCLUSION This sample of research literature on high-risk behaviors of female drug abusers shows much diversity in attention to contextual issues. There often is a lack of asking research questions, collecting data, and reporting findings from a perspective that includes enough information to form a picture of the contextual situation in which these women exist, use drugs, and succumb to HIV through high-risk behavior. Studies should attempt to not only present associations, but also to explain why there is continued high-risk behavior despite the danger. Information on the emotional, psychological, familial, and social-environmental contexts of high-risk behaviors among female drug users is sorely needed. Explanatory systems, such as level of differentiation of self, could help make sense of such statements as “I would like to get treatment for my drug use, but I know that being drug free is like a pie in the sky dream for me.” Bowen’s system also can be used to explain a number of current observations on both individual and community levels. From a community perspective, because Bowen’s theory posits that level of self-differentiation is passed down among generations and that children will be similar to parents in level of self-differentiation, one would not expect problems to be limited to individuals within a family. In fact, AIDS is affecting entire families and generations in African- American neighborhoods. An example is a 51-year-old IVDU woman who is HIV positive; her 36-year-old son just recently died of AIDS; and her sister recently died of AIDS. Another example of this phenomenon is a woman who injects heroin and is HIV positive; her daughter is cocaine addicted and is HIV positive from high-risk sexual behavior; and her daughter’s child is HIV positive. All of this in one family! Families in some African-American communities are accepting the disease and resulting death as a routine part of life, and children are growing up in environments where the norm is for many adults to have AIDS. The children are learning dysfunctional patterns (using drugs to deal with issues, make life comfortable, and relieve the anxiety of relationships and participation in high-risk behaviors) that may be passed on to other generations. 61
The lack of rational thought separated from emotions described by Bowen may be reflected in the following observation. When some patients find out they have AIDS, they experience it as something someone did to them. As a result, they are not motivated to protect others through condom use or not sharing needles. A low level of self-differentiation keeps people from advocating for themselves. When diagnosed with being HIV positive, some patients in hospitals hear about it from medical students or interns whom they do not identify as their physician. Sometimes, the diagnosis is given when the patient is being discharged, and no thorough information is given. Another phenomenon is the attitudes of medical and nursing staff toward the patients or clients. Staff may feel as if patients “do this to themselves” and may make comments like “Why don’t you go to another hospital or medical facility?” This response from staff contributes to poor self-esteem and perpetuates a sense of hopelessness. Patients may go back to using drugs to make themselves more comfortable, rather than feeling the anger, hurt, and disillusionment. Persons with high levels of self-differentiation would be able to negotiate the medical care system to avoid or at least confront such insensitivities. Finally, a consistent theme in research literature on HIV risk in women is that treatment for drug abuse can make an impact on high-risk behaviors for HIV transmission among female drug users. Therefore, drug treatment for women is a crucial intervention to provide the context and skills whereby women can lower their risk of HIV infection. REFERENCES Bowen, M. Family Therapy in Clinical Practice. New York: Jason Aronson, 1978. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report: Year End Edition. Atlanta: Centers for Disease Control and Prevention, 1993a. Centers for Disease Control and Prevention. U.S. AIDS cases reported through March 1993. HIV/AIDS Surveillance Report 5(1):3-19. Atlanta: Centers for Disease Control and Prevention, 1993b. Corby, N.; Wolitski, R.; Thornton-Johnson, S.; and Tanner, N. AIDS knowledge, perception of risk, and behaviors among female sex partners of injection drug users. AIDS Educ Prev 3(4):353-366, 1991. 62
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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
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Inciardi, J.A.; Lockwood, D.; and P
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highlights the critical importance
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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 and 60: found in this study was low socioec
Page 61 and 62: who trade sex for crack; and simila
Page 63 and 64: esponsibilities in perspective. Suc
Page 65: Robles and colleagues (1990) examin
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
Page 111 and 112: that they are intending or desirous
Page 113 and 114: enough is known in general about th
Page 115 and 116: 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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