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If asked to define racism, most people describe a dislike of people from other races. While that approximates a definition for personal prejudice, it fails to account for the full reality of racism. Racism, instead, is a system of power, characterized by a racial hierarchy. The fact that the popular definition fails to account for power or hierarchy is no accident. In fact, it speaks to the reason that so many White Americans can simultaneously reject racism as popularly defined, engage in racist behavior without knowing it, benefit from White privilege, and suffer from the impacts of racism. In this introductory chapter, we explore how a complete definition of racism helps establish the four primary theses of the book. First, we assert that White Americans are the source of racism. White Americans are the inventors, propagators, and benefactors of racism. Second, we argue that White Americans also suffer a cost for being the source of racism. White Americans gain unearned privileges from racism relative to people of color. Third, the costs of racism are not equally spread among all Whites. White privilege intersects with other social identities such as gender and socioeconomic class. Fourth, modern elites use social institutions to enforce the racial hierarchy in order to achieve their own goals. This has been especially true during the age of Trump. Donald Trump exploited existing racial divisions to garner White support in cutting taxes for billionaires, gutting social safety nets for those on the margins, and fortifying his own claim to power. In the process, everyday Whites suffered the impacts of racism.

This is a review of the theoretical development of the concept of racism. From its 1960s activist roots, the concept lost its theoretical content in its 1970s popularization. Now racism describes virtually anything having to do with racial conflict. The concept is reintroduced and used to analyze the post-1970s race relations propositions. The declining significance of race, symbolic racism, color-blind racism, and unconscious racism missed the structural regressions brought on by the “southern strategy” to mask indirect and covert ways to continue racial oppression. As a result, the new Jim Crow was missed in race relations since the 1980s. A reconsideration of the theory of racism calls for a strategic approach to race relations research. Research should focus on the etiology of racism among European Americans and the central role played by White elites and the media in maintaining historic cultural and institutional arrangements.

MORE was a mobile outreach drug abuse prevention and HIV harm reduction program primarily for ex-offenders who are active drug users. Through case management, clients were provided substance abuse education, counseling, and referral. Long term goals of these services were to reduce their drug use and re-incarceration for drug related crimes. From January 2002 to May 2006, 487 unduplicated clients were recruited in year long cohorts and offered services. The program evaluation tool was the Federal Office of Budget and Management Government Performance and Results Act questionnaire. Government Performance and Results Act interviews were conducted at in-take into the program, approximately six months later and again approximately 12 months after their initial in-take. By the six and 12 month follow-up interviews, active drug using clients reported significant reductions in their use of alcohol, cocaine/crack, heroin, and fewer sex partners and crimes. Program completers reported significantly reduced cocaine/crack and heroin use as well as fewer days in jail and crimes than non-completers (p.01 to .001). Six program components account for these reductions: case management, day-treatment, outpatient services, outreach, HIV/AIDS, and substance abuse education. The differences in program service intensity, income, and employment for program completers and non-completers were analyzed using logistic regression. The intensity of case management and all services received along with having higher income by month six were the most significant predictors of program completion.

The objective of this study was to ascertain the relationship among intravenous drug users between high levels of HIV risk-taking and both (a) deaths of significant others experienced before age 15, and (b) unresolved mourning; 592 out-of-treatment intravenous drug users (71.4% male; mean age = 40.5), stratified as to zip code, were recruited in San Jose, CA, as part of a CDC multisite investigation of access to sterile needles and HIV infection. HIV serostatus tests were obtained and an individual, structured interview administered covering demographics, employment, mental health, HIV risk-taking behavior, family contacts/closeness, and family deaths/mourning. Multivariate analyses indicated that the extent of HIV risk-taking in adulthood was highly and positively related to (a) the number of close-family-member deaths participants experienced as youth, (b) the extent to which respondents effectively mourned sudden family losses, (c) the extent to which those lost were emotionally close to the respondent, and (d) whether or not the respondent attended the funerals of lost relatives. Canonical correlations between sets of death/mourning and HIV risk-taking variables were .55 for the total sample (p < .001) and .70 for the subsample who experienced early and sudden family deaths (p < .001). In both analyses, it made little difference if age and gender were partialed out. These findings give credence to the importance of (a) unexpected deaths experienced early in life, and (b) related, inadequate mourning, as factors in progressively higher adult HIV risk-taking. They suggest that treatment for such individuals and their families should involve grief work dealing with unresolved losses within the family of origin. In addition, prevention efforts may have to revise their modus operandi toward both more focused and more family-based methods of outreach and engagement.

Concentrates on HIV/AIDS prevention practitioners and how the AIDS epidemic can be recognized in such a way as to influence individuals to assist in prevention. Highlights how the gay community, in particular, have managed to reduce deaths and infection but that the newer members of the community seem to be falling by the wayside now. Discusses social and psychological theories involved in the fight in AIDS prevention. States that in the USA the effective interventions being discontinued are the poorly funded or not at all. Concludes the fight against AIDS through publicity and knowledge must go on.

Background: Injection drug users (IDUs) and their sex partners account for an increasing proportion of new AIDS and HIV cases in the United States, but public debate and policy regarding the effectiveness of various HIV prevention programs for them must cite data from other countries, from non-street-recruited IDUs already in treatment, or other programs, and from infection rates for pathogens other than HIV. Methods: Participants were recruited from the street at six sites (Baltimore [Maryland], New York [two sites], Chicago [Illinois], San Jose [California], Los Angeles [California], and at a state women's correctional facility [Connecticut]), interviewed with a standard questionnaire, and located and reinterviewed at one or more follow-up visits (mean, 7.8 months later). HIV serostatus and participation in various programs and behaviors that could reduce HIV infection risk were determined at each visit. Results: In all, 3773 participants were recruited from the street, and 2306 (61%) were located and interviewed subsequently. Of 3562 initial serum specimens, 520 (14.6%) were HIV-seropositive; at subsequent assessment, 19 people, all from the East Coast and Chicago, had acquired HIV. Not using previously used needles was substantially protective against HIV acquisition (relative risk [RR], 0.29; 95% confidence interval [CI], 0.11-0.80) and, in a multivariate model, was significantly associated with use of needle and syringe exchange programs (adjusted odds ratio [OR adj ], 2.08; 95% CI, 1.15-3.85). Similarly, reduction of injection frequency was very protective against seroconversion (RR, 0.33; 95% CI, 0.14-0.80), and this behavior was strongly associated with participation in drug treatment programs (OR adj 3.54; 95% Cl, 2.50-5.00). In a separate analysis, only 37.5% of study-participants had sufficient new needles to meet their monthly demand. Conclusions: In this large multicity study of IDUs in the United States, several HIV prevention strategies appeared to be individually and partially effective; these results indicate the continued need for, and substantial gaps in, effective approaches to preventing HIV infection in drug users.

California Prevention Education Program (Cal-Pep) provides street outreach services to injection drugs users and sex traders in Oakland and San Francisco, CA, to reduce their chances of contracting HIV/AIDS. Drug treatment is an effective barrier to HIV infections, but only clients who are ready for total abstinence from drug use can be referred to traditional treatment. Drug treatment readiness is currently defined by funding policies in the U.S. as a client's willingness to totally abstain from alcohol and illegal drug use. This policy and practice eliminates a major harm reduction opportunity to reach drug users who are just contemplating recovery with treatment. With a CSAT grant to demonstrate an effective innovation in treatment, Cal-Pep started a harm reduction outpatient program for women who were active drug users. Over the course of 1 year, actively drug-using clients came to the program house during the day for meals, for risk-reduction education sessions, group discussions, and one-on-one psychological counselling.From April 2001 to March 2006, 37 clients per year were interviewed at program entry and after 6 and 12 months to see if the intervention activities had an impact on their drug use and readiness for abstinence drug treatment.By the 6th and 12th month of clients' progression through the risk-reduction program, they reported a statistically significant reduction in their poly-drug use (cocaine, cannabis, heroin, PCP) in the 30 days prior to their interviews (p.000). There were also significant reductions in poly-drug use with alcohol (p.000) and use of crack cocaine alone (p.003). There was also an added benefit: clients significantly improved their living circumstances from the streets and shelters to rooms and apartments while in the program (p.034). There was no significant improvement in employment.This intervention shows that a harm reduction intermediate treatment program for actively using drug users can significantly reduce their drug use and improve readiness for full recovery.

African-Americans are overrepresented among drug abusers in the United States when compared to European-Americans, and have lower rates of recovery from drug addiction after treatment. There has been no comprehensive research to date to specifically explain either this overrepresentation or lower rates of recovery among African-Americans. In this article, it is suggested that one reason for this lack of attention is due to the failure of drug abuse treatment providers and researchers to see race as a cultural rather than physical phenomenon. The point is made that cultural factors are intrinsic to successful efforts to address drug abuse among African-Americans. Several historic African-American coping strategies are outlined and shown to be powerful factors in client addictive behavior and barriers to recovery. Through case studies of clients who were successful in their effort to recover, the necessity to address cultural as well as personal issues is shown to be vital to successful recovery among African-Americans.

Increasing rates of sexually transmitted diseases among users of noninjection drugs prompt speculation that crack cocaine users who do not inject are at particularly high risk of HIV (human immunodeficiency virus) infection.A street recruitment technique was employed to enroll 331 primarily African-American men aged 18-29 in an area of San Francisco where crack cocaine is sold openly. One-half were regular crack users and the other half had never used the drug. Few reported injection drug use or male-to-male sex. In a face-to-face interview, participants reported on their drug use, knowledge of HIV, sexual practice, condom use, and demographic characteristics. Following counseling, each was tested for HIV and syphilis.Comparisons showed that demographically similar, crack users reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetime, and greater frequencies of paying for sex, exchanging sex for drugs, and having sex with injection drug users. Users reported greater current depression, anxiety, and social isolation. They reported earlier initiation into alcohol use and less positive parenting experiences during their adolescence.These results are consistent with findings that report the comorbidity of drug abuse and mental illness. Implications are drawn for reducing HIV infection among this high-risk population for early adolescent, community mental health, and substance abuse treatment programs.

It was assumed by many social scientists that a decline in prejudice would be accompanied by a decrease in racial discrimination; a change in belief would result in a change in behavior (Feagin and Feagin 1978: 3-5). Despite declines in survey-reported racial prejudice and the elimination of legally sanctioned and overt discrimination, blacks apparently are still experiencing racially motivated restrictions. At the beginning of the 1980s, blacks within the central city, as well as within newer suburban enclaves, are as tightly confined as ever in segregated communities (Tobin, 1979; Gappert and Knight, 1982). There is also little hope of further improving their circumstance relative to whites in the foreseeable future (U.S. Commission on Civil Rights, 1978; U.S. Bureau of Census, 1979; Hill, 1978; Jones, 1981). In looking at the changes that have occurred over the last fifteen years, some analysts see race as a declining factor in determining one's life chances (Wilson, 1978). Lack of improvement in black social and economic circumstance is now due to the economic class circumstance in a no-growth economy. There is another view. Although William Wilson (1978) would interpret this change as the decline of race as a