NDARC Technial Report No. 10 (1990)
INTRODUCTION
The HIV Risk-taking Behaviour Scale (HRBS) is a brief, 11 item questionnaire developed to measure the behaviour of intravenous drug users that puts them at risk of either contracting, or passing on, human immunodeficiency virus (HIV). Two predominant areas of concern exist in relation to the spread of HIV amongst this population and, via this route, to the broader community: needle use behaviour and sexual behaviour.
Research up until the present has found that high rates of needle sharing have been a common practice for some intravenous drug users (IVDU) (Morlet, Darke, Guinan, Wolk, & Gold, 1990; Skidmore, Robertson, & Roberts, 1989; Stimson, Donoghoe, & Dolan, 1988). It is now well known that the sharing of needles and syringes puts the IVDUs concerned at risk for HIV via the transmission route of HIV-contaminated blood (Centers for Disease Control, 1989). Although moves have been made in some countries to provide IVDU with easily available needles and syringes through the setting up of agencies like needle and syringe exchanges, this has not been a universally accepted practice on the part of governments. Even where needles and syringes are freely available, it has been found that some IVDU continue to share their injection equipment regardless of this availability and regardless of the risk they pose to themselves and to others (Darke, Hall, & Carless, 1990).
Given the high incidence of needle sharing among IVDU, injection equipment cleaning practices are of critical importance. Bleach has been shown to be viricidal and there have been education campaigns in many countries to encourage IVDU to clean their equipment with bleach if they are going to share. Clearly, if a person is sharing, then the decontamination procedures they have been using will need to be assessed to gain a proper impression of their risk for HIV.
The sexual behaviour of IVDU is also of major importance, both from the perspective of the spread of HIV within that population, and in relation to the spread of the virus to the nonintravenous drug using population (Feucht, Stephens, & Roman, 1990; Robertson, Skidmore, & Roberts, 1988). Again there has been a widespread emphasis on education to reduce risk in the area of sexual behaviour, though of course this has been focussed at the general population, not just at IVDU. The use of condoms has been encouraged as a form of safe sex. For IVDU, it could be argued that due to the added risk of needle sharing, the use of condoms should also be encouraged even with regular, monogamous sexual partners. It is not uncommon for female, and to a lesser extent male, IVDU to support their drug use by prostitution (Philpot, Harcourt, & Edwards, 1989). Engaging in prostitution is another potential area of risk for IVDU, not only for themselves, but for their customers if they engage in unsafe sexual practices. Finally, one sexual practice that has consistently been shown to be a high risk activity in relation to the spread of HIV is penetrative anal sex (Turner, Miller, & Moses, 1989). IVDU are as much at risk if they engage in anal sex as any other group.
In order for an instrument to thoroughly assess the HIV risk-taking behaviour of IVDU, all of the issues discussed above would have to be covered. It is not sufficient to address just those behaviours directly related to intravenous drug use. A group of people who are at risk for HIV due to their drug use practices may put others at risk if they engage in unprotected sex with them. They will, in addition, be at the same risk as anyone else of contracting and spreading the virus through sexual activity. Also, to be of utility in clinical settings, both as a screening instrument and as an indicator of behavioural change, an instrument to assess these HIV risk-taking behaviours should be brief, easy to administer, and acceptable to IVDU. The HRBS was constructed to provide such an instrument.