SOCIAL MISERY AND THE SANCTIONS OF SUBSTANCE-ABUSE - CONFRONTING HIV RISK AMONG HOMELESS HEROIN-ADDICTS IN SAN-FRANCISCO

Participant observation fieldwork among street-level heroin injectors in San Francisco demonstrates the need for contextualized understandin gs of how power relations structure individual behavior in the transmi ssion of HIV. Problematizing macro/micro dichotomies, we explore how e xternally-imposed power constraints are expressed in everyday practice s constituting differential HN infection rates within distinct populat ion groups. The pragmatics of income-generating strategies and the sym bolic hierarchies of respect and identity shape risky behavior. The po litical economy and symbolic representations of rare, class, gender, s exuality, and geography organize chronic social suffering and distort research data. Traditional paradigms of applied public health elide po wer relations and overemphasize individual behavior. Ignoring the cent rality of power prevents a full understanding of the who, why, how, an d where of HIV infection.