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U.S. Department of Health and Human Services

Archival Content: 1999-2005

HIV Prevention Among Drug Users:
A Resource Book for Community Planners & Program Managers


Part 2: Drug Use, Sexual Behavior, and HIV Risk

Recent estimates suggest that the HIV/AIDS epidemic in the U.S. is being driven by subepidemics in three groups: (1) injection drug users and their sex partners and children; (2) heterosexual women who use crack; and (3) young and minority men who have sex with men (Holmberg, 1996). Of these three subepidemics, two are directly associated with drug use and underscore the importance of drug use and sexual behaviors to the spread of HIV. In addition, there is some evidence that the third subepidemic also is associated with drug use. Among MSM, non-injection drug use (e.g., current or past heavy alcohol use; current use of stimulants, hallucinogens, and inhalants) (Woody et al., 1996) has been shown to be associated with higher-risk sexual behavior.

Drug users face many opportunities for HIV exposure, infection, and transmission as a result of their drug-using practices and sexual behaviors. In the past, HIV prevention efforts often focused on either the drug-related or the sex-related risk behaviors of individuals, neglecting both the interrelationships among these behaviors and the social context in which they occur. The association between non-injection drug use, such as crack cocaine, and sexually related risk behaviors has also been ignored. Now, however, those involved in efforts to contain the spread of HIV infection in drug users acknowledge a pressing need to focus on both drug-related (injection and non-injection) and sexually related risk behaviors.

PART 2 builds on the general information on drug use patterns and behaviors presented in PART 1 by focusing on the interface of HIV, drug use, and sexual behaviors, and by describing the HIV risks incurred by drug-using populations. It provides information to help HIV prevention planners and program managers take into account the multiple risks associated with drug use as well as the social conditions that uniquely influence the frequency and level of such risks.

Specifically, PART 2 will help HIV prevention planners and program managers increase their knowledge of:

  • drug-using practices, sexual behaviors, and the social context of drug use, all of which influence HIV infection risk
  • special groups of drug users who are most heavily affected by HIV
  • national, state, and local HIV/AIDS data available to help identify trends in transmission of HIV among drug users
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