It would be useful to explore how theoretical work might help to conceptualize the meaning of gender in HIV risk reduction and potentially improve understanding of the psychosocial context of HIV risk in a gender-specific manner. A gender-specific approach to prevention would take into account the broader social context of women's "permanent inequality" (Miller, 1986) in status and power relative to men, gender differences in psychosocial development, and gender role socialization. Investigating women's risk of HIV within this gender-specific framework is especially relevant because sexual and drug-using behaviors often occur within the context of relationships with men (Amaro, 1993).
Male partners play a critical role in women's initiation and progression of drug use, and in involvement in drug-related criminal activities such as prostitution (Anglin, Hser, and McGlothlin, 1987; Hser, Anglin, and McGlothlin, 1987; Rosenbaum, 1981; Worth and Rodriguez, 1987). For men, introduction and progression in drug use and related criminal activity occurs primarily through a same-sex friend. For women this occurs most often in the context of love or a sexual relationship or friendship with someone of the opposite sex. Thus, for women, addiction is often closely tied to love and sexual relationships with men, which brings a different dynamic into disengaging from drug use.
The impact of the male partner in women's drug use begins at an early age. Research indicates that adolescent girls with a male partner who uses marijuana and/or cocaine are three times more likely to use drugs during pregnancy and six time more likely to use drugs a year after delivery than girls whose partners did not use drugs (Amaro, Zuckerman, and Cabral, 1989). Having a male partner who uses drugs—especially heavier drug use—places girls at risk of drug use themselves (Amaro, Zuckerman, and Cabral, 1989), a finding that is consistent with reports among women addicts (Anglin, Hser, and McGlothlin, 1987) and women alcoholics (Lisansky Gomberg and Lisansky, 1984).
Some suggest that research that places women at the center of analysis should investigate women's efforts to transform sexual relationships, among other topics (Schneider, 1992). Research is needed to understand power relations between women and men and how these play out in the negotiation of safer sex, as well as the role of physical and sexual abuse and its impact on HIV risk reduction. Violence and abuse are a daily reality in the lives of many addicted women and among women with male partners who are addicted (Amaro et al., 1990; Fullilove, Fullilove, Kennedy, et al., 1992); but research is needed to document the extent to which