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The elimination of Native peoples and the enslavement of Africans in the U.S. more than qualify as acts of historical state sponsored genocide. A feature of both genocides is that they ended as institutional practices but have continued culturally and psychologically. The primary contemporary legacy of these genocides is racism which reinforces historical trauma and grief. Suggestions are made for how healing for Native and African Americans can begin despite ongoing racism. This includes psychological counseling for White Americans with beliefs in White supremacy. Suggestions are also made for how reconciliation can begin at the county-level between descendants of slave owners and enslaved Africans as well as between descendants of settlers and Native Americans.

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.

Those who are French by acquisition versus French by birth now represent a new challenge to French social stratification. Do social inequalities exist based upon cultural acquisition as opposed to birth? If so, are they increasing or decreasing? For the moment there is no way to answer these questions directly. The author conducted an ethnographic study in Parisian public spaces during the winter and spring of 2005. The central hypothesis is that social divisions can be observed and even measured in public spaces if representative social behaviors are recurring. The author described four patterns of deference in public spaces that people of color who are French by acquisition give to those who are self-identified French by birth. Suggestions were made of how these observations could be confirmed or not by others.

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.

Based upon process evaluations of two HIV/AID epidemiologic studies and one program evaluation, the authors focus on the subtle and culturally latent ways that respondents differentially make themselves available as research subjects. Our primary thesis is that injection drug users respond to opportunities to be interviewed and paid as a group as well as individuals. In which case, they influence as a group who is recruited for interviews. In this retrospective review, we show the ways that some IDUs respond differentially to research methods based on ways that they are organized in the larger community.

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.

Background and Objectives:Small ethnographic and clinic-based studies indicate that crack-smoking sex workers are at high risk for human immunodeficiency virus (HIV) and sexually transmitted diseases (STD).Study Goals:To examine the prevalence of risky sexual behaviors and HIV and STD in a large sam

A survey of 1220 street-recruited crack cocaine smokers revealed that crack smokers may turn to drug injection to ease crack withdrawal. Crack smokers who later injected tended to smoke crack more heavily and for longer periods than those who did not inject. The initiation of injection was significantly associated with ever snorting heroin (prevalence ratio [PR] = 3.4, 95% confidence interval [CI] = 2.0–5.9) or snorting heroin specifically while smoking crack (PR = 2.3, 95% CI = 1.3–4.0), suggesting that snorted heroin use may mediate the transition to injection among crack smokers. Programs to prevent and treat crack dependence may prevent later injection and injection-related infections including HIV.

Background and Methods The smoking of “crack” cocaine is thought to be associated with high-risk sexual practices that accelerate the spread of infection with the human immunodeficiency virus (HIV). We studied 2323 young adults, 18 to 29 years of age, who smoked crack regularly or who had never smoked crack. The study participants, recruited from the streets of inner-city neighborhoods in New York, Miami, and San Francisco, were interviewed and tested for HIV. This report presents the findings for the 1967 participants (85 percent) who had never injected drugs. Results Of the 1137 crack smokers, 15.7 percent were positive for HIV antibody, as compared with 5.2 percent of the 830 nonsmokers (prevalence ratio adjusted for the city, 2.4; 99 percent confidence interval, 1.7 to 3.6). The prevalence of HIV was highest among the crack-smoking women in New York (29.6 percent) and Miami (23.0 percent). In these two cities, of the 283 women who had sex in exchange for money or drugs, 30.4 percent were infected with...

UNLABELLED External influences on community-based drug treatment program outcomes have not been adequately accounted by either treatment providers or evaluators. In 2001-2003, a cohort of 197 African American and Latino crack cocaine and heroin users was interviewed at intake into the Free-at-Last's treatment program in East Palo Alto, California. OBJECTIVE The goal of this research was to identify, and then measure, the impact of a series of theory-based, hypothesized external influences on 3 client treatment outcomes: (1) program completers, (2) dropouts, and (3) referrals to more intensive inpatient treatment. METHODS All program clients were interviewed using the Government Performance and Results Act and the California Alcohol and Drug Data System questionnaires. Supplemental questions hypothesized the external influences and were based on prior research and staff focus groups. RESULTS There were statistically significant differences in treatment outcomes based on employment status, homelessness, living situation, and jail time. Regression analyses indicated that the strongest outcome predictors were treatment intensity, followed by prior crack use, homelessness, income, and number of illegal drugs used. Path analysis showed that former crack use and time in jail formed a particularly strong cluster of external influences on treatment outcomes. This cluster was the result of court-mandated treatment of arrested crack users who chose treatment over incarceration. If users failed treatment, they went back to jail. In a community such as East Palo Alto, court-mandated referrals had a powerful external influence on treatment and, therefore, need to be considered when evaluating a treatment program.

Twenty years is a long time in the life of a preventable epidemic. In 1990 when HIV was infecting and AIDS was killing white gay and bisexual men and threatening the general public, there was public concern about the disease and federal research and prevention dollars flowed. It was well established that HIV was spread primarily through sexual intercourse without barrier protection such as condoms. “Risky sex” occurred between men and between men and women. By 2000, HIV infection rates and deaths due to AIDS were in decline among White men in AIDS epi-centers, but continued among African Americans. The HIV/AIDS epidemic has not only continued its course among Blacks but also concentrated among black men and in black communities and has become yet another affliction among Blacks. At the very same time, public attention and urgency to the AIDS epidemic has waned and prevention dollars have been largely replaced by funding of clinical trials of new drugs. If you are Black and poor, there are now, in fact, more incentives to get infected with HIV to get social support through a clinical trial then to avoid getting infected in the first place. Public and government indifference to disease among Blacks but a willingness at the same time to use them in research are precisely the same reactions to disproportionate rates of yellow fever, typhus, syphilis, and tuberculosis among Blacks during Jim Crow segregation in the early twentieth century (McBride, 1991).

Since crack cocaine appeared in urban areas in the United States in the mid-1980s, reports have suggested that crack smokers may be at increased risk of sexually transmitted diseases (STDs), including infection with HIV, because they have multiple sex partners, trade sex for money or drugs, and rarely use condoms. A cross-sectional survey is being conducted in urban neighborhoods in Miami, New York and San Francisco--where crack use is common--to explore these issues. Indigenous street outreach workers are recruiting men and women who are either current regular crack smokers or who have never smoked crack; each group is further stratified according to whether participants had ever injected drugs. Participants were interviewed about their sexual and drug-use practices. Overall, crack smokers, whether injectors or not, engaged in higher-risk sexual behaviors than nonsmokers, reported greater numbers of sex partners than nonsmokers, and were more likely than nonsmokers to have exchanged sex for money or drugs or to have had an STD. Differences between crack smokers and nonsmokers were generally greater among non-injectors than among injectors, and generally greater among women than among men. Condom use, although somewhat more common with paying than nonpaying partners, was infrequent overall. Most of the subjects had not been in substance abuse treatment in the preceding 12 months, and a majority had never been in substance abuse treatment. Education and prevention programs specifically targeted at crack smokers not currently in substance abuse treatment are needed to reach these high-risk persons.

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.