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Observations on the Importance of Social Context in HIV Transmission among Intravenous Drug Users

Human immunodeficiency virus (HIV) is arguably the most significant health consequence associated with intravenous drug use. The primary mode for HIV transmission among intravenous drug users (IVDUs) is the sharing of contaminated hypodermic equipment. These activities take place under social conditions that may vary widely among different groups of IVDUs. In 1987, HIV seroprevalence among heterosexual IVDUs was approximately 15% in San Francisco and 50% in New York City. In New York City 31.6% of AIDS cases were diagnosed among heterosexual IVDUs, while 1.3% of AIDS cases fell into the same category in San Francisco. Different trajectories of HIV infection among IVDUs in San Francisco and New York are explored; possible explanations for disparities are considered; and the social contexts and conditions in which risk behavior takes place are discussed. Implications for public health policy, community-based interventions, and the efficacy of needle-exchange programs are explored.