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

geographically and demographically distinct points of entry of HIV
among IDUs: one in a northside neighborhood with a large concentration
of gay men, and the other among heterosexual Puerto Ricans several
miles away. Finding such demographic distinctions within populations of
IDUs even in a single city reinforces the need for further evaluation of
contextual variables contributing to HIV risk.
GAY AND BISEXUAL NONINJECTING DRUG USERS
In the following chapter, Ostrow focuses on the relationship of illicit drug
use with sexual HIV risk behaviors and HIV infection among
noninjecting gay and bisexual men, reviewing the published scientific
literature and highlighting research findings from the Chicago site of the
Multicenter AIDS Cohort Study, funded by the National Institute of
Allergy and Infectious Diseases, and its companion behavioral/mental
health study funded by the National Institute of Mental Health. As
reported by Ostrow, nonmedical drug use is clearly associated with highrisk
sexual behaviors and also with increased likelihood of HIV infection
in gay and bisexual men. However, the mechanisms that may account for
these associations are not clear; thus, it is uncertain whether high-risk
sexual behavior is causally related to drug use or if both behaviors are
manifestations of some common underlying factor. While causation is
not established, Ostrow notes that researchers currently know enough
about their association to permit targeting HIV prevention interventions.
DRUG USE AMONG MALE SEX WORKERS
In the second chapter of this section, Waldorf focuses on drug use and
HIV risk among male sex workers, reviewing the published scientific
literature and highlighting findings from two studies conducted in San
Francisco from 1987 to 1988 and from 1989 to 1991. As reported by
Waldorf, relatively few studies have assessed drug use among male sex
workers, and the extent of injecting drug use reported has varied
considerably. A significant contribution of Waldorf and his colleagues
was the differentiation of two types of male prostitutes, “hustlers” and
“call men,” with nine different subtypes, and their use of quota sampling
to permit study of the various subtypes. Waldorf reports that injectable
drugs, including methamphetamine, cocaine hydrochloride, and heroin,
were readily available in the areas of San Francisco where male sex
workers were concentrated, and high rates of injecting drug use were
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