Stigmatized Drug Use, Sexual Partner Concurrency, and Other Sex Risk Network and Behavior Characteristics of 18- to 24-Year- Old Youth in a High-Risk Neighborhood PETER L. FLOM, PHD,* SAMUEL R. FRIEDMAN, PHD,* BENNY J. KOTTIRI, PHD,* ALAN NEAIGUS, PHD,* RICHARD CURTIS, PHD, † DON C. DES JARLAIS, PHD,* ‡ MILAGROS SANDOVAL,* AND JONATHAN M. ZENILMAN, MD § Background: Sex risks and drug use are related. This rela- tion in youth is described. Goal: To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth. Study Design: In-person interviews were conducted with both a probability household sample (n  363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs. Results: Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concur- rent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and un- protected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men. Conclusions: Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually trans- mitted diseases. Drug use prevention, harm reduction inter- ventions, or both may lower this risk. AMONG THE MOST serious health problems facing youth are drug use, 1,2 HIV, 3–6 and other sexually transmitted in- fections (STIs). 7,8 Sex risk behaviors such as engaging in sex with multiple partners and not using condoms consis- tently are common among U.S. youth 9 in colleges 10 and specific neighborhoods, including poor, minority, and urban neighborhoods in general 11,12 and Bushwick (the site of the current research) in particular. 12 Of the 18- to 24-year-olds in a national study, 85% had been sexually active in the preceding year, and 32% reported sex with multiple part- ners. 13 One important but relatively unstudied sex risk net- work characteristic is involvement with concurrent partners. This characteristic has implications for the spread of HIV 14 and other STIs. 15,16 Sex risk behaviors and networks, drug use, and STIs are interrelated. Alcohol and other drug use are related to less consistent condom use among young men, 17 and to a higher number of sex partners among both young men, 18,19 and young women. 20 Among 18- to 30-year-olds, findings show that alcohol and marijuana are related to a greater likelihood of sexual activity and sex with multiple partners, but not to consistent condom use. 18,21 Drug and sex behaviors are complex, and social research- ers recently have begun to organize these behaviors into hierarchies. For example, for black and Puerto Rican ado- lescents in East Harlem, a stage measure of sex behavior (i.e., no involvement, deep kissing, petting, or sexual inter- course) was related to a stage model of drug usage (i.e., no drug use, alcohol or cigarette use only, use of marijuana but no other drugs, use of other illicit drug). 17 The authors thank Joy Settembrino, Elsie Rodriguez, Christine Broom, Jane Schmirler, Jane Rodriguez-White, Herminio Martinez, and all of the participants in this research. Drug Use and HIV Risk Among Youth is a study conducted at the Institute for AIDS Research, National Development and Research Insti- tutes, New York, New York. Supported by National Institute on Drug Abuse grant R01 DA10411 and National Institutes of Allergy and Infec- tious Diseases grants K24AI01633 and U19AI38533. Research approved by National Development and Research Institutes’ Institutional Review Board. Presented in part at the International Society for Sexually Transmitted Disease Research annual meeting, 11-14 July 1999, Denver, Colorado. Correspondence and reprint requests: Peter L. Flom, PHD, National Development and Research Institutes, Inc., 2 World Trade Center, 16th Floor, New York, NY 10048. E-mail: Peter.flom@ndri.org Received for publication December 4, 2000, revised March 1, 2001, and accepted March 6, 2001. From the *National Development and Research Institutes, New York, New York; the † John Jay College of Criminal Justice, New York, New York; the ‡ Beth Israel Medical Center, New York, New York; and the § Johns Hopkins University School of Medicine, Baltimore, Maryland 598