I. We have begun talking about risk groups and preventive behavior

A. While the concept of risk groups highlights risky behavior and groups that are likely to engage in those behaviors

1. This tends to lead to stereotypic assumptions about groups when we actually have little information
2. It also leads us and others to bring moral assumptions and beliefs to the discussion about HIV
3. It is worthwhile to be self-aware that we are doing this and to ask how our stereotypes and assumptions might be shaping our image of what is going on
4. It is important to collect information about the actual behavior of groups considered at risk, such as HIV drug users.

B. Among the consequences of defining risk groups is that we tend to create policies that react to our assumptions, stereotypes, and moral judgments about groups

1. Interventions may be ill matched to the actual risks and problems of the groups because we have inadequate information
2. We tend to ignore groups we perceive to be OUTSIDE the risks groups (like women) and to overlook ways that interventions will not work for them
3. When moral judgments guide the interventions we are willing to try, we may be making a definite, if indirect, statement that we are willing to put members of the subject group to death; this is what the article suggests is happening with drug abusers.

II. When speaking of drug abuse, it is important to understand the context of intervention and recovery, the context of use, and how it is that people begin to be users.

A. The main intervention for drug abuse is a 28-day inpatient stay at a drug rehabilitation center.

1. Often these visits happen because an individual has "bottomed out" and gotten in trouble with the law, with family, or with work.
2. Most of what we know about drug abuse comes in association with people being arrested and/or placed in publicly funded drug treatment centers.
3. We know very little about middle class people placed in private facilities
4. We also know very little about people who use drugs without having them disrupt their lives in a dramatic way.
5. Most studies show that only about 25% of people who go into in-patient rehab actually remain not using after leaving, although usage levels are generally reduced

B. It is important to recognize ways that the intravenous drug using population is heterogeneous.

1. Most of the research is on heroin users

a. Heroin turns out to be less addictive and less destructive than is commonly assumed to be the case.
b. People use intensively for a period of time and then stop using so intensively
c. People may use heroin occasionally or on weekends and not become addicted.

2. Injected cocaine seems much more serious for HIV because it seems to be associated with heightened sexuality, multiple injection, and prostitution.
3. The drug using population also is heterogeneous in terms of whether or not people are addicted.

a. Of approximately 1 million drug users nationwide, about 80% are intensive, habitual users
b. The 20% that are not may use occasionally or just on weekends
c. The occasional user population is able to maintain a normal life style and also comes from all social classes
d. While this is the case, they are still at high risk for infection
e. They also pose a special risk to the rest of the population because they are not separated from other "normal" groups

C. Intravenous drug use tends to be a social activity and this is the reason that it spreads and that it is so dangerous.

1. There is too little recognition of the way that drug use is related to high risk, heterosexual sexuality

a. Some drug use heightens sexual desires and increases the amount of risky sex
b. Women who are partners of drug users may be in a situation where it is impossible to demand safe sex

2. Drug users have to be socialized into the subculture of use in order to use drugs properly and in order for them to understand what there is to be enjoyed.

a. People normally are brought into the world of drug use by peers, siblings, or lovers so they introduction to drug use is inherently social
b. Newcomers need access to the drug, access to equipment, and instruction in use so that they are dependent on regular users in order to get started
c. Often there is a power imbalance/dependency relationship between the new user and those who introduce individuals to use.
d. An important part of drug using is that people do not immediately recognize what is enjoyable about being high

1. People have to be taught what to perceive about the aftereffect of drug use, what experience is meant by "being high"
2. There are unpleasant side-aspects of drug use, and people have to learn that these are not important.
3. People have to be taught how to use equipment and how to use so that they will not hurt themselves.
4. All of these steps also apply to learning to drink
5. That one has to learn to use drugs also means that the experience of being high starts off as one that is inherently social and that inherently involves sharing.

D. Research shows that drug abusers can and will dramatically change needle sharing behavior and drug use behavior if they are given a chance to do so.

1. Drug abusers are well informed about the HIV risk associated with use and various programs have shown that they will change their behavior when given the chance.
2. Thus needle exchange programs and distribution of effective cleaning equipment is an effective way to reduce spread of HIV
3. HIV is unevenly distributed through the drug abusing population, so that there is a great opportunity to limit the spread of new HIV cases through programs that give access to clean drug "works"
4. Drug abusers also show a willingness to enter into treatment programs if those programs are made available

a. Even though drug treatment programs are not very successful at terminating use, abusers who go through treatment programs use drugs less intensively
b. Research shows that less frequent use of drugs dramatically reduces risk (since people are exposed fewer times to the chance of encountering an HIV infected set of works).