Background
Both HIV/AIDS and crack use have increased dramatically in El Salvador over the last decade. Likewise, researchers have noted an alarming increase in the use of crack cocaine in the country as well as an increase in gang membership and violent crime.  HIV researchers working with active drug users in the U.S. have increasingly argued that interventions that focus only on changing individual risk behavior are insufficient to significantly reduce the spread of HIV. To understand and reduce HIV transmission, it is necessary to address the social context in which risky sexual practices and drug use occur and structural factors that may inhibit the ability of drug users to engage in HIV prevention behaviors. Particularly in developing countries, research is limited on structural factors that may influence the social context of drug use and HIV risk. To address these gaps, this 4-year study will conduct formative research on the structural factors and social context of HIV risk and drug use, within targeted communities in the San Salvador metropolitan area. Results from the study will then be used to develop and explore the feasibility and acceptability of an HIV prevention intervention in collaboration with community partners that will address both the social context in which crack use and unsafe sexual behavior occurs as well as community structural factors that can enhance or diminish prevention efforts.  

ICR has conducted numerous studies about the confluence of drug use, unsafe sex, and HIV risk on the local, national and international arenas. In Study of High-Risk Drug Use Settings for HIV Prevention, researchers observed sites where individuals inject and smoke drugs in Hartford, a similar approach to that used in San Salvador. Project staff then built on these findings to develop HIV Prevention in High-Risk Drug Use Sites: Project RAP, training active drug users to disseminate risk-reduction messages and materials to their peers who use drugs and in the places they use them. Internationally, ICR currently conducts HIV prevention research in India (International Initiatives to Prevent HIV/STD Infection) and China (Microbicide Acceptability for HIV/STD Prevention Among Female Sex Workers in Southern China). The current El Salvador project follows up on a pilot study that was the first to explore the social context in which crack is consumed and HIV occurs in that country.