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

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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 85
found among both hustlers and call men in both studies. Among these IDU male sex workers, Waldorf reports high levels of needle sharing, including sharing in communal settings such as shooting galleries and sex clubs. Waldorf concludes that unsafe sex and needle sharing place many male sex workers at risk for HIV infection. NOTE 1. While not all men who have sex with men identify themselves as gay or bisexual, for purposes of this introduction, “gay” is used to refer to men who report having had only male sexual partners. “Bisexual” refers to men who report having had both male and female sexual partners. It is recognized that such behavioral definitions do not necessarily equate with individuals’ self-identified sexual orientation. REFERENCES Battjes, R.J.; Pickens, R.W.; and Amsel, Z. Introduction of HIV infection among intravenous drug abusers in low prevalence areas. J Acquir Immune Defic Syndr 2:533-539, 1989. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report. Vol. 5, No. 3, 1993. Lampinen, T.M.; Joo, E.; Seweryn, S.; Wiebel, W.; and Chapman, B.T. “Race/Ethnicity Not Associated With HIV-1 Seropositivity Among Chicago Intravenous Drug Users (IVDUs): Confounding and Epidemic Duration.” Paper presented at the Seventh International Conference on AIDS, Florence, Italy, June 16-21, 1991. Stall, R., and Ostrow, D.G. Intravenous drug use, the combination of drugs and sexual activity and HIV infection among gay and bisexual men: The San Francisco Men’s Health Study. J Drug Issues 19:57-73, 1989. 86
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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
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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
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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 and 88: Drug Use and HIV Risk Among Gay and
Page 89: with 34.6 percent of gay men and 28
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
Page 139 and 140: 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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