Faculty Bibliography

Drug injectors have simultaneously faced a devastating HIV I AIDS epidemic and an intense program of government repression and media demonization known as the "War on Drugs." We address patterns of association (networks) among drug injectors; how these networks shape their norms toward condom use and safer sex; the extent to which drug injectors take it upon themselves to promulgate safer sex norms to others; and, on a different level of analysis, the extent to which drug injectors have created organizations to reduce HIV transmission and to deal with other problems. Data from 767 street-recruited Brooklyn drug injectors indicate that about half of their drug- injector network ties, and of their sexual network ties, have lasted for at least five years; perceived peer norms supportive of condom use are widespread; almost half had told others (in the last month) that they should use condoms, and this was particularly likely among those in an ethnographically defined core group; consistent condom use with non-drug-injectors is reported for 44 percent of such relationships, and is most likely if the drug injector is HIV-infected, if the relationship is not *very close," if peer norms support condom use and among those without network ties to the ethnographic core group. Observational and historical research on drug users' organizations is used to describe the activities of "users' groups" around the world. In spite of the pressures they have been under, drug users' organizations exist in many cities and are active in anti-HIV efforts. Thus, norms and networks affect risk networks; and norms themselves vary by social network location and by social role. In spite of being subjected to intense repression and stigma, drug users have acted to shape their own culture, to protect themselves and others against HIV/AIDS and, to some extent, have engaged in collective action through formal organizations. The possibility of dialectic response seems to extend even to the most oppressed, dependent and stigmatized members of humanity.

Since sexual transmission of HIV among and from drug injectors is a frequent source of infection, condom use by them is important for prevention. This paper focuses on predictors of condom use at last sex by drug injectors with 'activated motivation,' that is, by those who already are trying to use condoms to reduce HIV risk. Principal subjects are 1,240 drug injectors who report activated motivation to use condoms to prevent HIV and who had had sex within 6 months before the interview. Many used condoms at last sexual event with primary partners (65%) and with casual partners (80%). Condom use with primary partners increased over time, and was higher among those who knew they were HIV-positive or who talked about AIDS with sexual partners, but was lower among those who knew they were HIV-negative, who were Black, Hispanic, women, younger, or high school graduates, or who used crack with their partners at the sexual event. Condom use with casual partners was lower among women, older drug injectors, and those who were high on alcohol along with their partners, and tended to be more likely among those who know they are infected. Condom use with both primary and casual partners was greater with partners who did not themselves inject drugs. Programs should urge drug injectors who are trying to use condoms to avoid HIV transmission that having sex while using psychoactive substances may be a barrier to their doing so even if they want to use condoms and have done so in the past. Finally, research should be conducted to determine if persons with activated motivation should receive HIV prevention assistance that is different from that offered those who lack risk-reduction motivation or those who want to reduce their risk behaviors, but have been unable to implement the desired changes