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

instability was found to predict sexual risk for HIV transmission (Brown
and Weissman, in press).
Relationship Factors
Perhaps the most critical feature of many behavior changes that might
prevent the sexual transmission of HIV is that they require the
cooperation of another person, namely, the woman’s sex partner.
Unfortunately, some of the women most at risk are dependent upon their
male partners for economic security (Kane 1991). Some women also fear
that they will lose desired partners if they insist on condom use, since this
may be interpreted as an indication that the woman has been unfaithful to
her partner, believes that her partner has been unfaithful to her, or has
discovered that she is infected with HIV or other pathogenic agents (De
Bruyn 1992; Fullilove et al. 1990; Kenen and Armstrong 1992). Women
also may desire to become pregnant, militating against the use of
condoms or any other contraceptive (De Bruyn 1992; Kline et al. 1992).
Of particular concern is the plight of the woman experiencing domestic
violence or coerced sex, for whom the recommendation of condom use
may be impossible and even dangerous to execute. A recent study of the
sex partners of IDUs revealed alarmingly high rates of domestic violence
(Weissman 1991). While focus group members generally do not reveal
abuse in their own lives, they do comment that other women experience
it, as illustrated by one respondent’s statement, “It probably happens... in
90 percent of marriages and relationships where women live alone”
(Fullilove et al. 1990). Further, while the female condom (discussed
below) will give women some control over the safety of their encounters,
many of the problems that women experience in their attempts to be safe
will persist, since the presence of the female condom is quite obvious to
her partner.
Some investigators have suggested the potential utility of alternative
negotiation techniques, which involve giving reasons for condom use that
do not have to do with AIDS per se (Magana and Magana 1992; O’Leary
1991) and that therefore obviate many potential partner objections. The
woman might claim, for example, that her health care providers have
recommended condoms for contraception because she is allergic to semen
or to quell persistent yeast infections. Recommending to women that
they lie to their partners is a controversial strategy that carries obvious
risks (e.g., in abusive situations where they are most likely to be tried),
and may be seen as less healthy or desirable than other solutions such as
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