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Study of High-Risk Drug Use Settings
for HIV Prevention
Research Method:
Basic Research
Principal Investigators:
Margaret R. Weeks, Ph.D. (PI), Jean J. Schensul, Ph.D. (Co-PI),
Merrill Singer, Ph.D., HHC (Co-PI)
Grant:
National Institute on Mental Health
and the National Institute on Drug Abuse (#U01 DA07284, Project
#3). Grantee - Yale University Center for Interdisciplinary
Research on AIDS
Partners:
Hispanic Health Council, Yale University Center for Interdisciplinary
Research on AIDS
Dates of Study:
1997-2001
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Abstract
Research world-wide indicates that behaviors among active
drug users that places them at risk of HIV infection are driven
by a combination of individual, physiological, interpersonal,
community and social contextual issues. The majority of HIV
intervention models up to the early/mid 1990's focused on
community education and outreach, and on changing individual
beliefs, attitudes and risk behaviors of injection drug users
(IDUs). While these approaches had significant impact, research
indicated that a focus on individual behavior change did not
endure over time. Further community outreach approaches reached
only some, but certainly not all of those at highest risk
of exposure to HIV infection. New models were needed to reduce
opportunities for risk exposure directly, in the social contexts
in which infection among IDUs is transmitted.
This three-year, ethnographic study addressed this gap in
knowledge by identifying and learning about the locations
in which individuals inject and/or smoke illicit drugs and
exchange sex for money or drugs. It took the position that
characteristics of these locations might heighten risk of
exposure. If they could be identified, they could be addressed,
thus reducing risk of HIV infection at drug use sites. Through
observation, formal and informal interviews, documentation,
and surveys, the study explored the variations in types of
activities, structures and social relations constituting these
"high-risk" sites. Special emphasis was placed on
the dynamic process of site creation, modification, dissolution,
and reconstitution, to understand the factors influencing
this process over time, and the points at which risk might
be highest and intervention opportunities might occur. In
addition, the project explored and analyzed characteristics
of site users' personal networks to assess the viability of
a site-and-network-based, peer-led intervention program. Study
results led to a subsequent grant, "HIV
Prevention in High-Risk Drug Use Sites: Project RAP."
The study was one of four research projects funded under a
joint program between the National Institute of Mental Health
and the National Institute on Drug Abuse, which established
the Yale University Center for Interdisciplinary Research
on AIDS (CIRA) and furthered the AIDS prevention research
programs of the Institute for Community Research and the Hispanic
Health Council. Through this structure, the resources of Yale
University became available to the Hartford AIDS research
and intervention community; and the knowledge acquired through
prior years of investigation and intervention in Hartford
were shared with the small but growing Yale AIDS research
community.
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Project
Goals and Objectives
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Document the range of
variation in structures, social relations, and natural
histories of high-risk drug use settings in targeted
neighborhoods of Hartford, CT. |
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Describe and analyze
over time the properties of high-risk site users'
personal risk networks, including changes in shared
risk and preventive behaviors, network density and
stability, and changing pathways for diffusion of
HIV-risk or prevention effects. |
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Assess the degree to
which high-risk site gatekeepers (e.g., housemen
or dealers) and site users are receptive to on-site
prevention activities. |
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Assess the potential
for diffusion of benefits of a place-based, peer-leader
intervention for HIV risk reduction within and beyond
high-risk settings. |
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Project
Details/Research Findings
The project was completed in
2001. During the course of the three-year study,
project staff visited and conducted observation
of 85 drug-use sites in Hartford, and surveyed a
total of 293 drug users. Ethnographic observation
and formal/informal interviewing, combined with
the survey, provided information on patterns of
drug use, drug-use site characteristics, and presence
of prevention materials at these locations. Over
half of the study participants' primary and secondary
sites were public (abandoned buildings, parks, etc.).
Private sites were mostly homes or apartments of
users, close acquaintances, friends or friends'
contacts. Research results showed a greater presence
of prevention materials in private sites as compared
to public sites; while this indicates a greater
potential for prevention behavior, it does not necessarily
guarantee that these settings are less risky.
A key finding from the study was the unstable nature
of drug use sites. Project staff originally identified
14 sites (10 public, 4 private) for long-term observation.
Within two weeks, two of the sites were no longer
available, forcing staff to select new locations
for observation. Sites continued to become unavailable
throughout the project, making long-term site observation
difficult. However, documenting and understanding
the instability of both private and public sites
was a key finding in itself. The study also examined
the characteristics of drug-using networks within
the city and their relationship to particular sites.
Results showed a difference in network characteristics
based upon ethnic groups, reaffirming the need for
ethnic and culturally appropriate messages and intervention
strategies. Network analyses also demonstrated a
significant level of peer influence within networks,
confirming the potential for an effective peer-based
HIV-prevention program. The study resulted in a
subsequent intervention grant, "HIV
Prevention in High-Risk Drug Use Sites: Project
RAP" that is currently testing a peer-led,
place-based HIV prevention program, working with
many of the participants from this study.
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Project Contact:
Margaret R. Weeks, Ph.D.,
Principal Investigator
Associate Director, ICR
Jean J. Schensul, Ph.D.,
Co-Principal
Investigator
Executive Director, ICR
Project Staff:
ICR
Margaret R. Weeks, Ph.D.
Project Director
Jean J. Schensul, Ph.D.
Co-Project Director
Kim Radda, M.A., R.N.
Project Coordinator
D. Scott Wilson, Ph.D.
Project Ethnographer
Maria Martinez, H.S.
Outreach Worker
Robert Rooks, MSW
Project Coordinator (2)
HHC
Merrill Singer, Ph.D.
Co-Project Director
Delia Easton,
Project Ethnographer
Scott Clair, Ph.D.
Statistical Data Analyst
Glenn Scott
Outreach Worker
Yale
University
Michael Mersen, M.D., CIRA Principal Investigator
Kim Blankenship, Ph.D., Co-Project Director
Robert Heimer, Ph.D., Collaborator
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Link
to Research Methods page
Links to other ICR projects:
HIV Prevention
in High-Risk Drug Use Sites: Project RAP
External Links:
Hispanic
Health Council
Yale University Center
for Interdisciplinary Research on AIDS
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