Drug addicted women whose economic and social base is urban streets face limited options for income generation and multiple dangers of predation, assault, arrest, and illness. Exchanging sex for money or drugs offers one important source of income in this context. Yet the legal, social, and safety risks associated with these exchanges reduce the likelihood of regular safer sex practices during these encounters, thereby increasing the risk of HIV infection. Such conditions lead women engaged in sexual exchanges for money to varied and complex responses influenced by multiple and often contradictory pressures, both personal and contextual. Street-recruited women drug users in an AIDS prevention program in Hart-ford, Connecticut reported a range of condom use when engaging in sex for money exchanges. This paper explores their differences by ethnicity, economic resources, and drug use, and analyzes these and other factors that impact on street risks through sexual income generation. Surveys and in-depth interviews with drug-addicted women sex workers describe their various approaches to addressing multiple risks on the streets and suggest significant effort by women in these contexts to avoid the many risks, including HIV infection.

No abstract

This paper presents preliminary outcomes of a community-based AIDS prevention program for drug users called Project COPE II, the National Institute on Drug Abuse (NIDA) cooperative agreement study in Hartford, Connecticut. COPE II's efficacy study compares the NIDA standard intervention against two culturally targeted, enhanced interventions, one for African Americans and one for Puerto Ricans. A sample of 188 out-of-treatment injection drug users (IDUs) with matched baseline and 6-month follow-up interviews were compared for changes in monthly injection rates and proportionate use of new and pre-used needles and used injection supplies. Effects of injection outliers, attrition, and ethnic differences were examined for impact on outcome measures and to identify subgroups within the study population for whom the intervention had differential effects. These preliminary analyses suggest that attendance in culturally targeted enhanced interventions may increase the likelihood of positive program outcome, including drug-related risk reduction for some populations. However, subgroups of IDUs, such as extremely high injectors or individuals who drop out before initiating or completing the program, may require different intervention approaches. Further research is needed to understand the relationship between intervention and behavior change, reasons for attrition, and moderating factors affecting project outcomes.

No abstract