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

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A Contextual Perspective on HIV Risk Robert J. Battjes, Zili Sloboda, and William C. Grace For over a decade, acquired immunodeficiency syndrome (AIDS) has been identified as a major public health epidemic and a research priority of the National Institute on Drug Abuse (NIDA), the National Institutes of Health (NIH), and other components of the U.S. Public Health Service. Since the early years of the epidemic, needle and syringe sharing among injecting drug users (IDUs) has been recognized as a major vector for spread of the human immunodeficiency virus (HIV). Sexual transmission among IDUs, and from IDUs to non-IDU sexual partners, also has been a longstanding concern, as has perinatal transmission to their children. The number of IDUs diagnosed with AIDS continues to expand in the second decade of the epidemic, as does the number of related cases in IDUs’ sexual partners and their children. Approximately one-third of AIDS cases are associated with injecting drug use (Centers for Disease Control and Prevention 1993). The potential contribution of non-IDUs to HIV transmission and disease progression also has been of concern. For example, drug intoxication may lessen inhibition and facilitate engagement in sexual risk behaviors. Involvement in drug-using social networks may promote sexual contact between noninjectors and IDUs, increasing risk of HIV exposure. Some non-IDUs also engage in sex to obtain drugs or money to buy drugs. Recently, it has been recognized that crack cocaine users who engage in sex to obtain their drugs may be at especially high risk for HIV infection (Inciardi et al. 1992, 1993; Ratner 1993). Considerable progress has been made in identifying risk behaviors that contribute to HIV transmission and in enumerating the extent of injecting and sexual risk behaviors, especially for IDUs. However, much less progress has been made in clarifying the factors that may explain risk behaviors and barriers to risk reduction. To review research on drug-using and sexual behaviors of drug users that are associated with HIV transmission and to develop a research agenda for future research on risk behaviors, NIDA convened a technical review entitled The Context of HIV Risk Among Drug Users and Their Sexual 1
Partners. The review was held April 22 and 23, 1993, in Bethesda, Maryland. This monograph contains the papers presented at the technical review and recommendations emanating from it. The technical review on HIV risk behaviors evolved from an earlier meeting that NIDA convened in January 1992 as part of a planning process to develop NIDA’s 5-year plan for AIDS research. A number of areas for future research emerged from this planning meeting, with three priority areas identified for emphasis: Impact of the social context on drug injecting and drug-related sexual behaviors; Situational and temporal variations in injecting behaviors, especially considering the continuum of injection initiation, maintenance, risk reduction, and relapse; and Sexual behaviors and changes in sexual relationships in relation to developmental stages over time and in diverse interpersonal situations. These recommendations provided the foundation and framework for the technical review. The technical review considered injection-related risk behaviors of IDUs, sexual risk behaviors of IDUs and their sexual partners, and sexual risk behaviors associated with drug use in non-IDUs. The intent was to focus on the context of risk behaviors in order to clarify factors that contribute to or protect against risk and to thereby advance the knowledge base for future HIV-prevention strategies. In addressing the context of risk behaviors, authors were asked to consider situational, temporal, and developmental variation in risk behaviors, to consider differences based on level of risk (i.e., differences among individuals based on high, moderate, and low-risk behaviors), and the effects of competing risks (e.g., risks of withdrawal and overdose versus risk of HIV infection). Authors also were asked to consider psychological status, the dyad or social grouping in which behavior occurs, social networks, community context, culture, economic conditions, individual’s serostatus, and community AIDS prevalence. The monograph is organized into five sections. The first section, introduced by Needle, contains chapters on HIV risk behaviors of 2
Page 1 and 2: National Institute on Drug Abuse RE
Page 3 and 4: ACKNOWLEDGMENT This monograph is ba
Page 5: Drug Use and HIV Risk Among Male Se
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
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found in this study was low socioec
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who trade sex for crack; and simila
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esponsibilities in perspective. Suc
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Robles and colleagues (1990) examin
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The lack of rational thought separa
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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
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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
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O’Leary, A.; Celentano, D.; Maiba
Page 87 and 88:
Drug Use and HIV Risk Among Gay and
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with 34.6 percent of gay men and 28
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found among both hustlers and call
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Substance Use and HIV-Transmitting
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TABLE 1. Prevalence of substance us
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less than 2 percent of participants
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TABLE 2. Quantity of alcohol use am
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A fourth study of gay/bisexual men,
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in mind, however, that most of the
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seropositivity and reported NMPD us
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interaction and education than men
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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,
Page 119 and 120:
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
Page 155 and 156:
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
Page 161 and 162:
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
Page 261:
NIH Publication No. 94-3750 Printed
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