Balshem M, Oxman G, van Rooyen D, Girod K
Department of Anthropology, Portland State University, OR 97207-0751.
Soc Sci Med. 1992 Jul;35(2):147-60. doi: 10.1016/0277-9536(92)90162-j.
A new epidemic of syphilis in the Portland, Oregon metropolitan region mirrors a national trend in the United States. The epidemic is centered in urban areas, is associated with heterosexual transmission, and disproportionately affects people of color, especially African-Americans. The epidemic has been linked to sexual activity among users of crack cocaine, and particularly to the practice of trading sex and crack. Here, we report an analysis of in-depth interviews of 40 respondents, of whom 31 have used crack cocaine, 12 have experience as professional sex workers (prostitutes), and 12 are confirmed recent syphilis cases or their sexual contacts. These respondents confirm that sexual activity involving multiple anonymous partners often takes place within the context of crack cocaine use. They also describe sexual activity among more casual users of the drug. But respondents present themselves as having maintained an adherence to common American values regarding cleanliness, mortality, and sexual behavior. They speak of choosing sex partners according to whether a prospective partner 'looks clean.' This image of cleanliness goes beyond simple bodily hygiene, and into the realm of judgement about moral character. A person is more likely to be judged clean if he or she is known to come from a nice family, has a pleasant demeanor, or appears concerned about self-control. Such people are seen as fundamentally decent, and therefore less likely to have syphilis, a disease associated with deterioration, tearing down, dirtiness and disordering. Thus, respondents use conceptions of cleanliness and morality in constructing definitions of high- and low-risk sexual behavior, as they negotiate a life that endangers their sense of moral control. In doing this, they invoke beliefs and values central to the dominant culture surrounding them. This points to the limits of defining crack cocaine users, and other communities of drug users, as being culturally different from the rest of us.
俄勒冈州波特兰市大都市区梅毒疫情再现美国全国趋势。疫情集中在城市地区，与异性传播有关，对有色人种影响尤甚，特别是非裔美国人。该疫情与快克可卡因使用者的性行为有关，尤其与以性交易快克的行为相关。在此，我们报告对40名受访者进行深入访谈的分析结果，其中31人使用过快克可卡因，12人有过职业性工作者（妓女）经历，12人是近期确诊的梅毒病例或其性接触者。这些受访者证实，涉及多个匿名性伴侣的性行为常在快克可卡因使用背景下发生。他们还描述了该药物不太固定使用者之间的性行为。但受访者称自己一直秉持美国关于清洁、道德及性行为的常见价值观。他们谈到根据潜在性伴侣是否“看起来干净”来选择性伴侣。这种清洁观念不仅限于简单的身体卫生，还涉及对道德品质的评判。如果一个人来自良好家庭、举止宜人或看起来有自控能力，就更可能被认为干净。这类人被视为本质上正派，因此感染梅毒的可能性较小，梅毒是一种与堕落、破败、肮脏和混乱相关的疾病。因此，受访者在构建高风险和低风险性行为定义时运用清洁和道德观念，同时他们要应对危及自身道德控制感的生活。在此过程中，他们援引周围主流文化核心的信仰和价值观。这表明将快克可卡因使用者及其他吸毒群体定义为在文化上与我们其他人不同存在局限性。
