Academic journal article Journal of Drug Issues

The Efficacy of Network-Based HIV/AIDS Risk Reduction Programs in Midsized Towns in the United States

Academic journal article Journal of Drug Issues

The Efficacy of Network-Based HIV/AIDS Risk Reduction Programs in Midsized Towns in the United States

Article excerpt

Combining current psychosocial theories with social network outreach and prevention paradigms is an effective mechanism for reducing both drugrelated and sexual risks for HIV transmission in active drug users in midsized towns in the United States. Five hundred and seventy-nine individuals were recruited in two towns, one of SO,000 and one of 10,000 population. Three approaches to intervention were tested. These approaches included: (I) an intensive outreach program using indigenous outreach workers providing reinforcement of an HIV risk reduction program, and (2) a low intensity outreach program combined with a more intensive office-based HIV risk reduction program. Both conditions were compared with the National Institute on Drug Abuse (NIDA) recommended standard intervention. Each of the enhanced interventions produced a reduction in HIV-related risk taking reported by the participants. The intensive outreach combined with office intervention and the intensive office intervention without outreach reinforcement each produced significant reductions in sexual risk taking in active drug users, beyond the reductions reported for the NIDA standard program. The enhanced risk reduction programs produced differential impacts for males and females, respectively, between the two high and low intensity outreach models.

Introduction

As of December 1994, nearly 442,000 people were diagnosed with AIDS in the United States (CDC 1994). Drug users, particularly intravenous drug users (IDUs) and crack smokers represent the second highest risk level for infection of HIV (CDC 1994), as many not-in-treatment drug users continue to engage in high risk behaviors (Decker and Rosenfeld 1992). Heterosexual transmission from drug users (especially crack cocaine smokers) to non-drug users has been identified increasingly as a major area of concern for containing the HIV epidemic (Mathias 1993).

Community outreach targeting HIV prevention in active (not-in-treatment) drug users began in the early 1980s. These risk reduction efforts occurred primarily in urban areas and generally included a street outreach component to locate drug users and provide interventions either on the street or in project offices. A review of some of the earliest HIV/AIDS prevention projects directed to drug users (specifically IDUs) indicates that most projects were concerned exclusively with information dissemination (Schuster 1988). Researchers conducting such studies agree that although knowledge regarding HIV/AIDS is necessary, it is not sufficient for behavior change to occur among this population (McAuliffe 1988; Nyanjom et al. 1988; Des Jarlais et al. 1990). Observational studies are indicating that IDUs are willing to modify their HIV-risking behavior when risk reduction messages are made culturally relevant (Friedman et al. 1986, 1990), delivered and reinforced by a credible source (Stephens et al. 1993), and when demonstrations of technical and interpersonal skills are provided (Rhodes et al. 1992).

In 1987, the National AIDS Demonstration Research NADR program was initiated to target community-based HIV prevention efforts to not-in-treatment IDUs and their sexual partners (Brown and Beschner 1993; Stephens et al. 1993). After 3 years of operation (by mid-1991), 41 programs participating in the NADR project had interviewed approximately 60,000 drug users and sexual partners who were at risk of contracting HIV/AIDS (Simpson et al. 1994). NADR-sponsored projects were encouraged to develop and evaluate their own unique intervention strategies and research designs. For example, a handful of sites chose to target outreach interventions to drug injecting "networks" in designated neighborhoods, rather than assign individuals to intervention. In the majority of cases, however, projects randomly assigned clients to one of two interventions: either a "standard" or an "enhanced" intervention. The standard intervention was typically shorter and involved fewer training opportunities, whereas the enhanced version provided a number of additions to the standard services and often emphasized demonstrations or "skills training" practice in needle cleaning and condom use (Simpson et al. …

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