Academic journal article Health and Social Work

Linking Injection Drug Users to Medical Services: Role of Street Outreach Referrals

Academic journal article Health and Social Work

Linking Injection Drug Users to Medical Services: Role of Street Outreach Referrals

Article excerpt

A traditional role of social workers has been to link disadvantaged community members with service agencies. However, the rise of HIV infection among injection drug users (IDUs) has necessitated the use of indigenous street outreach workers to fulfill this role (Ashery, Davis, Davis, & Ross, 1993). Street outreach workers currently provide a range of services that help prevent the spread of HIV, including risk-reduction messages and instruction; distribution of bleach, condoms, or both; and referrals to medical services (Anderson et al., 1996). Although street outreach is an important means of "reducing and overcoming institutional barriers to health care for disadvantaged groups" (Valentine & Wright-DeAguero, 1996, p. 73), published studies on HIV and social workers have not examined this emerging function of street outreach and its implications for the social work profession. Those studies have focused on three areas of concern: stress and burnout from providing direct services to clients infected with HIV (Bennett, Kelaher, & Ross, 1994; Cushman, Evans, & Namerow, 1995; Wade, Beckerman, & Stein, 1996), challenges faced by practitioners who work directly with people with AIDS (Beckerman & Rock, 1996; Miah, Mizanur, & Ray, 1994; Napoleone, 1988), and social workers' knowledge of and attitudes about AIDS (Knight, 1996; Shi et al., 1993; Stewart & Reppucci, 1994).

Most published studies on street outreach and IDUs have focused on risk behavior (Anderson et al., 1996; Birkel et al., 1993; Wechsberg, Smith, & Harris-Adeeyo, 1992) or the operations of community-based outreach projects (Abdul-Quader et al., 1992; Broadhead & Heckathorn, 1994). As a result, there is only limited knowledge of the relationship between street outreach referrals and IDUs' acting on those referrals. Two studies suggest that street outreach workers have been able to persuade IDUs to enter substance abuse treatment, especially when the workers offer coupons for free treatment (Ashery et al., 1993; Bux, Iguchi, Lidz, Baxgter, & Platt 1993). Outreach workers' success with other types of medical referrals for this population is not documented in the literature.

In 1991 the Centers for Disease Control (CDC) began the AIDS Evaluation of Street Outreach Project (AESOP), a five-year collaborative research study that targeted IDUs in five cities: Atlanta, Chicago, Los Angeles, New York, and Philadelphia. This study was designed to increase understanding of client characteristics, service delivery, and the effects of street outreach programs on the risk behaviors of high-risk populations (CDC, 1993). The scope and efficacy of outreach were measured through cross-sectional interviews before and after site-specific program enhancements were implemented.

In addition to questioning IDUs about their high-risk behaviors, the AESOP interviewers gathered information on the interactions between IDUs and outreach workers, including interaction regarding referrals to medical services. That IDUs reported contact with outreach workers representing many different agencies in the five cities - not just the agencies affiliated with AESOP - presented an opportunity to examine the role of street outreach in providing medical referrals and encouraging this population to act on these referrals. This article addresses the following research questions:

* What level of exposure to street outreach services did IDUs report (what was their frequency of contact, did they have contact with workers delivering the AESOP enhancements, and had they seen skill-building demonstrations for safer sex and drug-using behaviors)?

* What were the most common medical referrals provided during such contacts?

* Did IDUs report acting on these referrals?

* What were the predictors of acting on referrals?

Table 1. AESOP Enhancements Related to Medical Service Referrals

Site                              Activities

Atlanta        On-site STD testing and counseling and HIV C&T
               through mobile van; training of peer educators to
               assist in the referral process; training of outreach
               workers to stage(a) IDUs for readiness to change risk
               behaviors. … 
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