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

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GAY AND BISEXUAL INJECTING DRUG USERS NIDA’s AIDS research 5-year planning process (see Battjes et al., this volume) identified the dual risk group of gay and bisexual men who inject drugs as a major research gap. Relatively little research has focused specifically on this population, although they comprise 6 percent of all AIDS cases, 10 percent of AIDS cases occurring in men who report sex with men, and 21 percent of AIDS cases occurring in IDUs (Centers for Disease Control and Prevention 1993). AIDS case data indicate that persons in this dual risk group are at substantially increased risk for AIDS compared with persons reporting either risk behavior alone. While men who have sex with men comprise 21 percent of AIDS cases in IDUs, it appears that relatively few of this dual risk group are reached through the primary HIV prevention initiatives that target drug abusers (i.e., drug abuse treatment and AIDS outreach programs). For example, in NIDA’s HIV Seroprevalence Survey, which studied IDUs admitted to methadone treatment in nine U.S. cities between 1987 and 1991, only 0.8 percent of approximately 6,400 male IDUs reported having exclusively homosexual sexual contacts within the previous year, while another 0.9 percent reported both male and female sexual partners (Battjes, unpublished data). In the NIDA-supported National AIDS Demonstration Research (NADR) program, which evaluated street outreach to IDUs at 61 sites between 1987 and 1992, only 2.2 percent of approximately 35,000 males reported having only male sexual partners within the prior 6 months, while 2.9 percent reported having both male and female sexual partners (Needle, personal communication, March 1993). In the NIDA-supported HIV Outreach Cooperative Agreement research program, which is evaluating HIV outreach and counseling to IDUs and crack cocaine users in 22 cities, only 2 percent of approximately 4,100 males enrolled between January 1992 and April 1993 reported having either exclusively male or both male and female sexual partners (Needle, personal communication, March 1993). Increased risk of HIV infection in this dual risk group compared with non-IDU gay and bisexual men has been reported by Stall and Ostrow (1989) in their analysis of gay and bisexual men participating in the San Francisco Men’s Health Study. At study entry, 88.2 percent (30 of 34) of gay and bisexual men who reported injecting drug use were HIV seropositive, compared with 46.2 percent (189 of 409) of non-IDU gay and bisexual men. Gay and bisexual male IDUs in NIDA’s HIV Seroprevalence Survey were more likely to be infected than other IDUs, 83
with 34.6 percent of gay men and 28.6 percent of bisexual men HIV seropositive compared with 13.2 percent of men reporting no male sexual partners (Battjes, unpublished data). In the NADR study, gay IDUs were similarly more likely to be HIV seropositive (34.6 percent), while bisexual male IDUs were slightly less likely to be HIV seropositive (16.4 percent) compared with males reporting no male sexual partners (18.7 percent). Assessing gay and bisexual men together in the Cooperative Agreement program, 39.3 percent of these men were HIV seropositive compared with 10.7 percent of men reporting no male sexual partners (Needle, unpublished data). Stall and Ostrow (1989) also found that gay and bisexual male IDUs were more likely to report high-risk sexual activity at study entry (67.7 percent) than non-IDU gay and bisexual men (45.1 percent). Comparing the sexual risk of gay and bisexual IDUs with male IDUs reporting no male sexual partners in the HIV Seroprevalence Survey, 28.9 percent of gay and 46.4 percent of bisexual males reported receiving payment for sex, compared with 7.0 percent of other men. Yet gay IDUs also were more likely to use condoms, with 20.7 percent reporting always using condoms, compared with 11.8 percent of bisexual male IDUs and 8.0 percent of other male IDUs (Battjes, unpublished data). Similarly in the NADR study, 35.8 percent of gay IDUs and 64.3 percent of bisexual male IDUs reported receiving payment for sex, compared with 6.8 percent of other male IDUs. Also, 18.8 percent of gay IDUs reported always using condoms, compared with 8.5 percent of bisexual male IDUs and 8.3 percent of other male IDUs (Needle, unpublished data). This dual risk group of gay and bisexual IDUs is important not only in its own right, but also because persons reporting dual risk may serve as a bridge for HIV transmission between heterosexual and lesbian IDUs and non-IDU gay and bisexual men. For example, in a study of IDUs entering methadone treatment in four low HIV prevalence areas, Battjes and colleagues (1989) found that the only behavioral difference between HIV seropositive and seronegative IDUs was self-reported sharing of needles or syringes with gay or bisexual men. Of seropositives, 25.0 percent reported such needle sharing, compared with 3.1 percent of seronegatives (adjusted odds ratio = 5.44). In Chicago, Lampinen and colleagues (1991) found that almost all of the earliest IDU-associated AIDS cases (diagnosed between 1982 and 1986) were among men who also reported sex with other men, suggesting that they may have acquired their infection sexually rather than parenterally. They further found that the geographic distribution of AIDS cases within Chicago suggested two 84
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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
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Chitwood, D.D.; McCoy, C.B.; Inciar
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Page, J.B.; Smith, P.C.; and Kane,
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HIV/AIDS Risks Among Male, Heterose
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during that time, and the possibili
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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 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: Drug Use and HIV Risk Among Gay and
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
Page 129 and 130: TABLE 2. Injection Drug Use by Type
Page 131 and 132: By the 100th interview, the screeni
Page 133 and 134: SUMMARY AND CONCLUSIONS In general,
Page 135 and 136: Plant, M. Sex work, alcohol, drugs
Page 137 and 138: 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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