Challenges in Research on Drug and Sexual Risk Practices of Men Who Have Sex with Men: Applications of Ethnography in HIV Epidemiology and Prevention

Epidemiological studies of persons who engage in illicit or illegal activities suffer from methodological difficulties in population definition and specification. Additionally, particularly in the context of HIV research, studies often lack the specificity and validity needed to understand and intervene in the behavioral practices by which viral pathogens such as HIV are transmitted. These limitations are particularly complicated in research among populations of drug-involved, men who have sex with men (DU/MSM), a hidden but internally diverse population which varies in both sexual behavior and drug use patterns across a number of complex and interacting dimensions. The challenges become even more profound when we factor in complexities of sexual identity and identity formation, the debilitating effects of multiple sources of stigma, and the economic imperatives that underpin drug and sexual risk practices among some groups of DU/MSM. This paper describes some of the uses of ethnographic methods, particularly participant-observation, in specifying the nature and interrelationship between risk practices among DU/MSM. We also show how ethnography can contribute to the process of disentangling the independent effects of age, period, and cohort factors, a perennial problem in epidemiological research in out-of-treatment populations.