embracing this perception will be ineffective in slowing the spread of HIV. Instead, prevention programs must begin with the knowledge that intravenous drug users are a heterogeneous population. Ethnicity, drugs of choice, neighborhood, economic class, cultural traditions, jobs or hustle, sex and sexual orientation, and age are some of the more obvious factors that differentiate users ( Feldman and Biemacki 1988; Des Jarlais, Friedman, and Strung 1986; Des Jarlais and Friedman 1989; Jimenez 1989; Koester 1989; Mason 1989; Mays and Cochran 1988; Schoenbaum et al. 1989; Watters 1989). This diversity directly affects the ecology of HIV transmission and makes it imperative that we develop prevention strategies cognizant of these differences ( Stall, Watters, and Case 1989).
In addition to acknowledging the diversity of IDUs, it is essential that we identify and understand the social context in which they live. Programs that focus only on changing high-risk behavior and the values that support it will fall short. Our efforts must also address the conditions that promote and maintain this behavior. Finally, we have learned that drug users are often consumed by a variety of personal, economic, and legal problems. We cannot assume that they share our level of concern about HIV. Helping them deal with these other problems may be an indirect but possibly more effective way of reducing their high-risk behavior.
By combining ongoing ethnographic research with an AIDS intervention effort employing indigenous outreach workers, we have been able to identify differences between networks of drug users in Denver and to design intervention strategies to accommodate them. We feel that our program has made significant progress in teaching drug users about HIV and what they can do to lessen their risk of contracting it. Five percent of Colorado's current AIDS cases are attributable to intravenous drug use as the single risk factor. This percentage has not shown any significant increase in three years. In addition, the combined seroprevalence rate of all active IDUs tested as part of our project and those tested at Denver AIDS Prevention's Counseling and Testing site has remained at approximately 3 percent since our project was implemented ( Koester and Cooper 1990). We hope our project has played a role in maintaining this low seroprevalence rate. We believe that we have been most successful in encouraging safer drug use and least successful in altering sexual behavior. As we continue our efforts, we intend to address this shortcoming by developing new educational strategies and by directly accessing sexual partners of drug users. This seems to be a common challenge for many HIV prevention projects.
This chapter is based on ethnographic research conducted as part of NIDA contract 271-87-8208 and DA 06912-01.