Alternative Strategies for Sexual Risk Reduction Used by Active Drug Users

Recent studies continue to document lack of consistent condom use by active drug users. However, personal HIV risk reduction strategies other than, or in addition to, condom use may be practiced. In this study, data from qualitative interviews with 92 active users of crack and injection drugs illustrate risk reduction strategies employed either instead of or in addition to condom usage. Findings are based on narrative accounts of methods used to reduce personal risk of contracting HIV during sexual acts. Precoital alternative strategies focused on partner selection techniques based on the belief that safe partners can be selected. Coital strategies included the selection of specific sex acts that were presumed to be safe or safer than others or cleanliness rituals or both. Postcoital strategies included techniques such as washing sex organs with bleach or lemon juice. Implications of these findings for intervention and prevention efforts are discussed.