This paper explores community structural factors in different low-income communities in the San Salvador, El Salvador that account for differences in the social context in which crack is used and in the HIV risk behaviors among crack users. Download Powtoon Gratis Offline. Results suggest that both more distal (type of low-income community, level of violent crime and poverty) and proximate structural factors (type of site where drugs are used, and whether drugs are used within or outside of community of residence) influence HIV risk behaviors among drug users. Additionally, our results suggest that community structural factors influence the historical and geographic variation in drug use sites. Crack use and related sexual risk are growing problems in urban El Salvador. The prevalence of crack use in El Salvador is high (;; ). Studies have identified a 4.9% prevalence of crack use among 18 year olds (), and 65% prevalence among young gang members ().

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In 2006, 100% of those receiving drug treatment in El Salvador received treatment for cocaine and crack (). High risk sexual practices are common among crack users (;;; ). In particular, our research has identified high levels of sexual risk behavior among crack users in El Salvador including sex with multiple partners, inconsistent or non-use of condoms, and high rates of sex exchanges ().

Much research has shown that the sexual risk associated with crack use is dependent on the social context in which crack is used (). As in other urban environments, crack is used in a variety of social settings in the San Salvador Metropolitan Area including private residences, trances (special locations in which crack is sold and used), motels, abandoned buildings or the street (; ). These different settings are also the context of sexual risk practices such as sex exchanges for money or drugs, sex while high, and sexual victimization (; ). HIV research has increasingly called attention to the need to better understand structural factors that increase certain populations’ vulnerability to HIV infection (;; ). Structural factors have been variously defined, but often refer to factors that are outside individuals’ immediate control (). Structural factors include environmental, economic or contextual characteristics that have more proximal or distal impacts on individuals’ behaviors and health outcomes (;;;; ). HIV research among drug users has explored the effects of a number of structural factors on HIV risk behaviors, from more distal community-level factors such as policing practices, crime and social disorder, and economic opportunities (;; ), to more proximate factors such as the social settings where drugs are consumed (; ).