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

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ecause it covers more tissue area (Nowak 1993). As mentioned above, the presence of the female condom is obvious to the male; thus, issues of trust remain potentially problematic. An issue that has become the subject of much debate but woefully little research is the recommendation that women use spermicide alone when the protection afforded by a condom is not a possible option (Cates et al. 1992; Rosenberg and Gollub 1992; Stein 1992). These would be situations in which women perceive themselves as helpless to prevent unprotected encounters, as in cases of rape and domestic violence. (Of course, these events would have to be predictable for the woman to be able to insert the spermicide). Indeed, many service providers in the community are recommending this measure, which obviously does not depend upon male cooperation. Arguments in favor of this recommendation include the in vitro virucidal effects of nonoxynol-9 (North 1990), and the speculation that the lubrication afforded by spermicidal gels may prevent tearing of the skin during episodes of coerced sex. However, because frequent use of nonoxynol-9 has been shown to disrupt the outer lining of the cervix and vagina in some women (Niruthisard et al. 1991), it is possible that transmission may be facilitated in some cases by this strategy. Indeed, in an experimental study in which commercial sex workers in Nairobi were randomized to receive either a nonoxynol-9–containing sponge or placebo cream, no effect on HIV seroconversion was observed (Kreiss et al. 1992). This study has been criticized as flawed in design and nongeneralizable in results (Rosenberg and Gollub 1992); however, it suggests the need for conservativism in recommending this prevention strategy. Furthermore, some intervention specialists express concern about giving complex or mixed messages, particularly given the extreme paucity of data regarding the effectiveness of this strategy. GENERAL ISSUES IN PREVENTION OF AIDS IN AT-RISK WOMEN Prevention efforts may not reach the women most in need, as many innercity women are isolated and not attached to community agencies. Individualized outreach by trusted others is the most effective way to recruit disenfranchised women, particularly Hispanic women. When possible, integration of AIDS prevention intervention with ongoing trusted services already part of women’s lives is likely to enhance maintenance of change. Emotional support for the client on the part of 73
the change agent may be a crucial factor in promoting change (National Institute of Mental Health 1992). Interventions must take realities of women’s lives into consideration, for example, by providing transportation and childcare. Interventions for couples, or at least ones that involve the partner to some degree, must be developed. There is a need for innovative prevention programs and programs that capitalize on cultural strengths. Intervention will be more effective if provided within community sources such as community-based organizations, neighborhood groups, or tenant groups. Formal or informal community leaders should be involved in prevention efforts. Alternative education strategies such as “telenovelas,” street theater, and Spanish-language radio and television programs also should be considered. The cohesion and mutual caring that exist within the families and communities of African-American and Hispanic individuals can be used to advantage in AIDS prevention. Mays and Cochran (1988) have suggested that prevention approaches for ethnic minority individuals should focus on the individual as a responsible member of a familial or social network. Recent work by Kelly and colleagues (1991, 1992) in gay communities has demonstrated the promise of diffusion of innovation models for AIDS prevention; this approach seems well-suited to the socially cohesive Hispanic community as well. There is a crucial need for education and services related to violence and domestic abuse as well as creation of alternatives to remaining in abusive relationships. AIDS prevention efforts must address issues of abuse if they are to be effective and maintain the safety of the women they are trying to reach. There is also a need to document behavioral changes other than condom use that women may be using in the belief, correct or incorrect, that they may decrease risk. Behaviors involving partner selection, use of withdrawal, antibody testing, and sexual history-taking (O’Leary et al. 1992) may be tried in response to AIDS prevention messages; these behaviors need to be both documented and studied for effectiveness. A great need also exists for research on woman-controlled technologies for AIDS prevention. 74
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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
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involves using a syringe to draw bl
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Hispanics were less likely to repor
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victimization through theft, violen
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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 and 70: Factors Associated With Sexual Risk
Page 71 and 72: Factors Associated With Poverty A n
Page 73 and 74: encouraging such women to leave the
Page 75 and 76: Hispanic women but extramarital aff
Page 77: coherence—the sense that life is
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
Page 121 and 122: prostitutes were HIV positive, as c
Page 123 and 124: Trade hustlers are usually heterose
Page 125 and 126: TABLE 1. Number of Completed Interv
Page 127 and 128: 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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The Context of HIV Risk Among Drug Users and Their Sexual Partners

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