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

African Americans, disease, and immoral behavior. The ethnicity and
sensitivity of the deliverer of the message that AIDS is an issue of
importance to the African-American community is likely to be a critical
factor in its acceptance.
Yet another feature of some elements of African-American culture that
may impact response to AIDS messages is adhesion to folk and spiritual
beliefs regarding disease etiology and treatment (Landrine and Klonoff
1994). To the extent that an individual holds these beliefs, one might
expect low receptiveness to biomedical-based messages regarding
transmission as well as treatment. A study of low-income African
Americans living in the Los Angeles area revealed prevalent beliefs in
spiritual forces, witchcraft, and evil influences as causative agents for
HIV and AIDS (Flaskerud and Rush 1989).
Hispanic Women. Like African-American culture, Hispanic culture is
distinguished in numerous ways of relevance for AIDS. While it should
be noted that there are numerous Hispanic cultures corresponding to
different geographical regions and countries, a number of characteristics
are shared by most or all (Marin and Marin 1991). The literature has
characterized Hispanic women as having conservative religious beliefs
and gender roles in which they are willing to sacrifice themselves for
their children and are passive and subordinate to men (Canino 1982;
Rivera 1985). These findings must be interpreted with caution because
they are not derived from controlled studies and often do not account for
demographic and socioeconomic variables. One strong cultural value
that has been established is “familismo,” or an emphasis on family as the
primary social unit and source of support, with less emphasis on
individualistic achievement than in the dominant culture (Marin and
Marin 1991). Children and fertility are highly valued; motherhood brings
high status within the family structure; and desire for fertility has been
shown to be a barrier to safer sex recommendations for Hispanics (Marin,
in press; Marin and Marin 1991). However, it also has been suggested
that this family orientation can be used to enhance motivation for
behavior change to reduce the risk of AIDS, for example, by appealing to
the health of unborn children (Marin, in press).
Many Hispanic women are at risk for HIV infection due to the behavior
of their husbands (Magana and Magana 1992; Marin, in press). Injection
drug use is prevalent among Hispanics, particularly those living in the
Northeast United States and Puerto Rico (Magana and Magana 1992).
Hispanic cultural norms promote virginity and monogamous marriage for
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