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

ecome a prominent source of female infection. In the United States, the
proportion of women who have contracted AIDS via heterosexual
activity has increased from 11 percent in 1984 to 34 percent in 1990, and
this proportion is increasing over time (Ellerbock et al. 1991).
Worldwide, it is estimated that 71 percent of HIV transmission occurred
through heterosexual contact (Ehrhardt 1992). Some fear that the United
States may ultimately become a “Pattern II” country with 50 percent of
those affected being women, as is the case now in some African countries
(Haverkos and Edelman 1988).
At the present time, AIDS in the United States affects predominantly the
inner-city poor, the majority of whom are people of color. African-
American and Hispanic women are disproportionately affected. While
whites account for only 27 percent of AIDS cases in women, about 50
percent of women with AIDS are African American, and about 20
percent are Hispanic (Chu et al. 1990). About 73 percent of mothers with
HIV-infected children receive public assistance (Shayne and Kaplan
1991). Commercial sex workers also are greatly at risk for HIV infection
(Centers for Disease Control and Prevention 1987; Cohen et al. 1988).
Most women with AIDS who have been infected heterosexually
(although possibly no longer most of those with early-stage HIV
infection) were infected by injecting drug-using (IDU) partners (Fordyce
et al. 1991). This is not surprising given the high seroprevalence rates of
IDUs (Centers for Disease Control and Prevention 1989), their low rates
of condom use (Lewis and Watters 1991; Weissman et al. 1991), and the
fact that sexual partners may not know of their partners’ drug use (Kane
1991).
In the absence of a cure or preventive vaccination against HIV infection,
behavior change remains the primary available means for combating this
epidemic. The most widely accepted method for preventing sexual
transmission of HIV in the United States, apart from abstinence, is the use
of latex condoms.
The following is a review of correlates of sexual risk that have been
identified among disenfranchised women. It is not restricted to research
on female partners of IDUs, although papers focusing specifically on this
population are included. A variety of factors associated with sexual risk
in women have been identified. These include factors related to poverty,
partner/relationship issues, cultural factors, beliefs and attitudes regarding
condoms, and personal characteristics. Each of these will be discussed in
turn.
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