America Living With AIDS

psychoactive substances, including
alcohol and crack cocaine, poses a
substantial risk. Sexual transmission
with regard to substance use occurs
when judgment about safer sex is
impaired as well as when sex is traded
for drugs.
Prevention messages about sexual
behavior as well as drug use may be
effectively conveyed in drug treatment
programs. Unfortunately, drug treatment opportunities, deficient for men,
are in even shorter supply for women.
This problem is in part a continuation
of prior inequities, for women have
traditionally had difficulty gaining
access to drug treatment facilities,
which for the most part have been oriented toward the needs of men.
Women with children and pregnant
women who use drugs often have special difficulty finding drug treatment
that meets their needs. Women in
need of treatment are often single parents who attend to their children's
needs before their own. Even when
pregnant drug users are accepted into
treatment, a significant opportunity
for intervention may be missed, since
there are often no provisions for prenatal care.
Sexual partners of individuals who
use intravenous drugs are often
unaware of the risks they face, either
because their partner's drug use is
covert, or part of the past, or because
they are unaware of the associated risks
of HIV. Those who are aware of the
risks may still face difficulty in seeking
counseling for risk reduction. Thus,
the simple steps that must be taken to
prevent AIDS, such as condom use,
may not be so simple after all.

Adolescents may be at heightened
risk for transmission through sexual
activity in conjunction with the use of
substances other than injection drugs.
While some studies indicate that adolescents may avoid intravenous drug
use, the use of alcohol and the growing use (especially in low-income
urban communities) of crack cocaine
places these individuals at increased
risk. It is extremely important, therefore, not to assume that intravenous
drug use is the only link between
drugs and sexual transmission.
REDUCING HIV TRAN MIS iN
RELATfED TO
INTRAVENOUS I)DR U SE
Successful and sustained risk reduction among injection drug users is
vital to slowing the spread of HIV
infection. Injection drug users place
themselves at risk through a variety of
behaviors, and may spread the virus
not only to their needle-sharing peers,
but also to their sexual partners and at
birth to their offspring. Hence, any
potentially successful program must
address drug use and sexual behaviors
simultaneously. It is also important to
provide prevention education to all
those who engage in the risk behavior
of sharing injection equipment,
including athletes who inject steroids
and individuals who inject vitamins
and medications.
Although there is a commonly held
misconception that drug users in the
throes of addiction are impervious to
messages about the risk of HIV trans
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