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

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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. 65
Factors Associated With Poverty A number of aspects of poverty affect the ability of women to protect themselves. These include enhanced risk for drug addiction, high prevalence of sexually transmitted diseases (STDs), and competing life concerns. Poverty also contributes to economic dependence of some women on their partners (Airhihenbuwa et al. 1992); relationship factors contributing to risk are the topic of the next section. Poverty and the pain that accompanies it contribute to the use of psychotropic drugs, including heroin, crack and other forms of cocaine, and alcohol. Injection of drugs created the initial vector for HIV infection in the inner city. Further, use of psychotropic substances militates against people’s ability to practice safer sexual behaviors (Leigh and Stall 1993). One reason for this relationship may be the clouding of judgment that occurs when people are under the influence of such substances; another is that addicted women often exchange sex for the drug that they need (Corby et al. 1991). Female partners of IDUs report high levels of use of illegal drugs and alcohol (Corby et al. 1991; Weissman et al. 1991) and concomitantly high levels of sexual risk (Brown and Weissman, in press). However, it should be noted that one study found that exchanging sex for drugs was not associated with higher sexual risk for women (Brown and Weissman, in press). Another aspect of inner-city life that contributes to AIDS risk for its female inhabitants is the high prevalence of other STDs that are endemic to these areas. Diseases such as syphilis, gonorrhea, chlamydia, pelvic inflammatory disease, human papillomavirus, and chancroid are severe epidemics in the inner city (Aral and Holmes 1991; Hatcher et al. 1990; Hayes 1987; Hofferth and Hayes 1987; Rothenberg 1991). Populations with higher rates of STDs are at increased risk for HIV infection. The risks of STDs and HIV are similar because both are caused by unprotected sexual activity. In addition, the presence of an STD and associated lesions may facilitate transmission of HIV. It has been posited that the burdened, crisis-driven lifestyle frequently associated with poverty may contribute to AIDS risk by displacing HIV infection among the list of concerns on peoples’ minds (Amaro 1988; Guarnaccia et al. 1989; Marin and Marin 1991; Nyamathi and Vasquez 1989). Indeed, results from a recent study support this notion in that the female respondents listed AIDS below several other life problems in seriousness (Kalichman et al. 1992). In a study of IDUs, residential 66
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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.
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Blower and colleagues (1991) have p
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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 and 66: Robles and colleagues (1990) examin
Page 67 and 68: The lack of rational thought separa
Page 69: Factors Associated With Sexual Risk
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,
Page 117 and 118: 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
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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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