Keeping it together: Stigma, response, and perception of risk in relationships between drug injectors and crack smokers, and other community residents

Abstract

Sexual relations between drug injectors (IDUs) and crack smokers (CS), and non-drug users are a major means of HIV spread to the broader population. However there is little literature describing community processes that regulate sexual and social partnerships among these groups. We describe these relationships in Bushwick, a low-income, mainly Latino neighbourhood in Brooklyn, NY. In this community, IDU and CS are heavily stigmatized, both by non-users and by some users. Known IDU/CS may find it harder to start and maintain social and sexual relationships, and to get jobs or support. Partially as a result of this stigma, IDU/CS attempt to ‘keep it together’ and hide either their drug use or its extent from other residents. Nevertheless, other residents believe, sometimes falsely, that they can distinguish users from nonusers. We describe some potential negative consequences of these beliefs and interactions, including their effects on risk for HIV and other sexually transmitted diseases.

Acknowledgments

Support was provided by National Institute on Drug Abuse grant R01 DA13128 (Networks, Norms and HIV Risk Among Youth), grant R01 DA10411 (Drug Use and HIV Risk among Youth), and by National Institute of Mental Health grant R01 MH62280 (Local Context, Social-Control Action, and HIV Risk). We would like to thank Herminio Martinez, Elsie Rodriguez, Jane Rodriguez-White and Joy Settembrino for conducting and arranging for survey interviews and Jennifer Page for transcribing qualitative interviews.