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

encouraging such women to leave their partners. However, in cases when
other options are not realistic or might take considerable time, careful
exploration of such possibilities would seem justified for some women.
Cultural Factors
As noted above, women of African and Hispanic descent are
disproportionately represented among women with AIDS. Thus, cultural
factors that distinguish these cultures are seen by many as being highly
relevant to AIDS prevention efforts in the communities most at risk
(Airhihenbuwa et al. 1992). While such considerations may be useful in
designing interventions aimed at these groups as a whole (e.g., in mass
media or marketing applications), it should not be assumed that that they
apply to every individual member of an ethnic group.
African-American Women. Only very limited data are available on the
prevalence and correlates of most sexual behaviors other than
contraceptive use among African-American women (Reinisch et al. 1988;
Turner et al. 1989). While African and African-American cultures are
generally regarded as very “sex-positive” and comfortable with
discussions of sexuality, it has been observed that poor African-American
women may exhibit less varied sexual repertories than white women
(Wyatt et al. 1988a, 1988b). They may equate intimacy specifically with
vaginal sex or penetration, an emphasis that may be related to an
orientation to procreation rather than erotic sex, possibly related in turn to
conservative religious values (Houston-Hamilton 1988). Caution also has
been urged in providing AIDS education that may be at odds with
established values. For example, the suggestion that women should
explore new forms of sexual behavior (e.g., nonpenetrative sexual
techniques) as a means of prevention of HIV transmission may be
received ambivalently by women subject to victim-blaming because of
stereotypes about their sexual behavior (Hine and Wittenstein 1989).
Another aspect of African-American culture relevant to AIDS prevention
efforts in that community are issues of trust in health care professionals
and mainstream health services (Airhihenbuwa et al. 1992; Thomas and
Quinn 1991). Distrust also may contribute to delay in seeking services.
It has been argued that African-American women’s resistance to admit
sexual risk is driven by fear of racial and sexual backlash (Hine and
Wittenstein 1989). There is fear that in the course of addressing the
AIDS problem, the African-American community will open itself to
additional discrimination by furthering the stereotypical association of
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