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Sexual Partner Choice in Injecting Drg Users It is thus possible, from these data, to estimate a one-year proportional percentage for at-risk activities in this sam pIe by providing data on the proportional percentage of sexual contacts in IDUs as well as number of partners. The small number of cases who reported no sexual contact in the past year (less than 5%) suggests that these estima tes are reasonably accu rate although deady the proportion of non-sexually active respondents must be taken into account in estimation of HIV infection risk. A knowledge of the distribution of partner type and number is essential to estimating HIV spread from and within IDUs, particularly to heterosexual persons with no other risk factors. However, a knowledge of the precise HIV infection risk is also needed, and this would involve not only a description of the type of sexual partner, but also the precise nature of the sexual interaction on the last sexual encounter. We do not have such data for this sample. Co-factors, such as STDs, and the fact that intoxication during sexual activity is commonly reported for IDUs, will also affect HIV transmission and the probability of safer sex. ln addition to the advantages of more accurate estimation of the risk of HIV transmission among and from IDUs, there are two further significant advantages in the method used in this study. The use of a "critical incident" as opposed to a general recollection of sexual behaviour is more likely to aid ace urate recall of incidents past by seeking recall of the context and actors in a specifie interaction. Second, in an epidemiological sense, it can act, in a sufficiently large sample, to give a proportional estima te of the distribution of behaviours. To use this, additional information on frequency of such behaviours within a specifie period as well as partner numbers is required. Temporal distribution of sexual behaviour must also be taken into account, as there are large seasonal distributions in STD rates which suggest that sexual behaviour is not evenly distributed across the year. Using last and second-Iast contacts in a sufficiently large and hopefully as representative as possible a sample can also provide an index of reliability or stability of the behaviours being investigated as weIl as data on context. ln summary, these data both demonstrate the use of a "critical incident" (proportional percentage) measure to identify as accurately as possible the distribution of types of individuals with whom sexual behaviours are engaged in, and the relative stability of such data by using as a comparison the previous sexual encounter. These data suggest that the difference between male and female IDUs in terms of IDU partners is not as great as has previously been estimated, and that, 89
90 Revue sex%gique / Sex%gica/ Review particularly for male IDUs, there is more instability (mixing across occasions) between IDU and non-IDU partners. Homosexual contact accounted for more than one in ten of contacts for both males and females, but bisexuality of partners was not recognized by any respondent, suggesting that it is either not discussed or not considered an option, and that it may have limited use as a risk concept in HIV risk reduction campaigns, at least for IDUs. These latter points also have major implications for spread of HIV beyond the commonly recognized transmission groups in Western societies. ACKNOWLEDGMENTS This study was funded by a Commonwealth AIDS Research Grant and forms part of a national study of HIV infection risks in IDUs. The work of Michael Drury, Jill Thomas, SaI Renshaw, Peter Karlsson, Vivienne Griffin, Leslie Armstrong, Neil Carroll, Simon Nimmo, Helen Johns, Vanessa French, Leanne Alvos and Paul Fleming on this study is gratefully acknowledged, as are the helpful comments of Dr Jonathan Elford. REFERENCES DARKE, S.; HALL, W. ; CARLESS, J. (1990). "Drug use, injecting practices and sexual behaviour of opioid users in Sydney, Australia. " British Journal of Addiction, 85, 1603-1609. DARKE, S. ; HALL, W. ; HEATH ER, N.; WARD, J.; WODAK, A (1991). "The reliability and validity of a scale to measure HIV risk-taking behaviour amongst intravenous drug users. " AIDS 5, 181-185. DO NOGHOE, M.C. ; STIMSON, G.V.; DOLAN, K.A. (1989). "Sexual behaviour of injecting drug users and associated risks of HIV infection for non-injecting sexual partners." AIDS Care 1, 51-58. FORDYCE, E.J.; BLUM, S. ; BALANON, A.; STONEBURNER, R. (1991). "A method for estimating HIV transmission rates among female sex partners of male intravenous drug users. " American Journal of Epidemiology 133, 590-598. JONES, c.; VLAHOV, D. (1989). "Why don't intravenous drug users use condoms?" Journal of Acquired Immune Deficiency Syndrome 2, 416-417. HARCOURT, c.; PHILPOT, R. (1990). "Female prostitutes, AIDS, drugs and alcohol in NSW." In: PL ANT, M. (ed.), AIDS, Drugs and Prostitution. Routledge: London, 132-158. KLEE, H. ; FAUGIER, J.; HAYES, c.; BOULTON, T.; MORRIS, J. (1990). "Factors associated with risk behaviour among injecting drug users." AIDS Care 2, 133-145.
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REVUE SEXOLOGIQUE SEXOLOGICAL REVIE
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Comité de geston 1 Managing Board
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Articles Revue sexologique / Sexolo
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Sexological Revie 1993, Vol. 1, No.
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FIGURE 1 1 o Modèle d'analyse des
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Contraception et prophylaxie chez d
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