Prevention Among IV Drug Users
and Social Policy Implications
More than a decade after the discovery of human immunodeficiency virus (HIV), prevention remains our only known means of slowing its spread. Developing prevention efforts for many of those at risk is complicated by these individuals' life-styles, by the discrimination they endure from mainstream American society, and by their reaction to such discrimination. Overcoming these barriers is a public health challenge of unparalleled dimensions. This chapter describes an attempt to meet this challenge by reaching out to drug injectors in Denver and attempting to help them lessen their chances of becoming infected with HIV. It describes how we access these marginalized and alienated individuals in three ethnically distinct neighborhoods. It details distinctions between these communities and their drug-using members, and it explains our efforts to design and implement intervention strategies that are relevant to the ethnic and cultural realities of each community.
The key elements in our intervention are the former drug users who take our prevention message to the city's drug-using population and the application of ethnography as both a research tool and a means of directing the outreach effort. The former drug users who become trained HIV prevention outreach workers and who are indigenous to the neighborhoods where they work are the single most important component of the approach described. Their understanding of the injector's life-style and their familiarity with these individuals allow us to overcome drug users' initial suspicions and develop working relationships with them. Maintaining an ongoing ethnographic research effort provides insights into the communities where we intervene and gives us a better understanding of their similarities and differences. This information is then used to augment or adjust our prevention program. In the following pages, this public health model is described, and its usefulness and limitations are examined. Qualitative research findings