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The authors present a model of interactive social psychological and relational feedback processes leading to human immunodeficiency virus (HIV) risk reduction behavior change among active drug users trained as Peer Health Advocates (PHAs). The model is supported by data from qualitative interviews with PHAs and members of their drug-using networks in the Risk Avoidance Partnership (RAP) project. Results suggest three mutually reinforcing social psychological processes that motivate PHAs to provide HIV prevention intervention to their peers and to reduce their own risk behaviors: development of a prosocial identity, positive social reinforcement from drug users and community members, and cognitive dissonance associated with continued risk behavior while engaging in health advocacy. These processes directly influence peer interventionists' motivation and efficacy to continue giving intervention to their peers, and to reduce their HIV risk behaviors. The authors discuss implications of the model for continued research on effective HIV prevention in high-risk groups. (Contains 1 figure and 1 table.)

China faces a rapidly emerging HIV epidemic and nationwide resurgence of sexually transmitted infections associated with a growing sex industry. Community empowerment and capacity building through community-based participatory research partnerships show promise for developing, testing, and refining multilevel interventions suited to the local context that are effective and appropriate to address these concerns. However, such efforts are fraught with challenges, both for community collaborators and for researchers. We have built an international team of scientists from Beijing and the United States and collaborating health policy makers, health educators, and care providers from Hainan and Guangxi Province Centers for Disease Prevention and Control and the local counties and towns where we are conducting our study. This team is in the process of testing a community-wide, multilevel intervention to promote female condoms and other HIV prevention within sex-work establishments. This article presents lessons learned from our experiences in the first two study sites of this intervention trial.

Heterosexually transmitted HIV remains of critical concern in the United States and around the world, especially among vulnerable and disadvantaged women, complicated by socioeconomic circumstances, gender power, addiction, and experiences of abuse, among other conditions. Effective woman-initiated HIV prevention options, such as the female condom (FC), are needed that women can use in different sexual relationship contexts. We conducted a behavioral and attitudinal survey with 461 primarily African American and Latina (especially Puerto Rican) women in Hartford, Connecticut, to measure factors on the individual, partner relationship, peer, and community levels influencing their initial and continued use of FC (using the prototype FC1) for disease prevention. We used multivariate analyses and structural equation modeling to assess effects of multiple level factors on FC use and unprotected sex with primary, casual, and paying partners. Initial, recent, and continued FC use was associated with factors on the individual level (education, marital status, drug use, child abuse experiences, HIV status), partner level (number of sex partners, paying sex partner, relationship power), and peer level (more or influential peers saying positive things about FC). Community level factors of availability and support were consistently poor across all sectors, which limited overall FC use. Patterns differed between African American and Latina women in stages and contexts of FC use and unprotected sex. FC can make a valuable contribution to reducing heterosexually transmitted HIV among women in many circumstances. The greatest barrier to increased FC use is the lack of a supportive community environment for its promotion and use. DOI: 10.1089/apc.2009.0312

Efforts have expanded to create AIDS prevention programs for drug users that consider the social context and interpersonal relationships within which risky practices take place. The Risk Avoidance Partnership (RAP) project is designed to train active drug users as peer/public health advocates (PHAs) to bring a structured, peer-led intervention into the sites where they and their drug-using social networks use illicit drugs. The RAP peer health advocacy training curriculum and peer-led intervention promote harm reduction among drug users and support drug-user organization to reduce infectious disease and other harm in the context of injection drug use, crack cocaine use, and sexual activity. Initial findings suggest that RAP PHAs perceive a significant positive role change in themselves while conducting health advocacy work and willingly and successfully carry the peer-led intervention into locations of high-risk drug activity to deliver it to their peers even in the absence of project staff support.

Vaginal microbicides could provide an important option for women in the prevention of HIV and other STIs. Researchers have examined women's preferences for specific product characteristics; however, much remains to be learned about women's willingness to use them with a variety of partners. This study examined high-risk women's experiences using simulated microbicides during a two-week trial. Ninety-six women completed the trial by using the product and reporting their experiences with different partner types. Analyses were conducted to examine differences between women who always used the product and those who used it less than all the time and whether risk and relationship attitudes were associated with simulated microbicide use during participants' most recent sexual encounters. All participants used the product and on an average of 79-94% of sexual encounters. The majority of the participants reported liking the simulated product. Women indicated that they would want to use microbicides in order to feel in control of their health, to avoid having to ask their partner, and because microbicides would be easier to use than condoms. Women who used the product 100% of the time had less relationship power; however, greater sexual assertiveness for STI prevention predicted simulated microbicide use during the most recent sexual encounter, and interventions may need to focus on promoting sexual assertiveness for disease prevention, KEYWORDS. Microbicides, HIV prevention, sexual assertiveness, acceptability

The Study of High Risk Drug Use Settings for HIV Prevention was designed to increase knowledge of urban social contexts in which drugs are consumed. In this article, we use ethnographic methods to focus on one subtype of drug use setting in Hartford, Connecticut, private sites with gatekeepers. We analyze the social interactions of drug users who use these sites to explore the contradictory social processes that sometimes facilitate and at other times impede intervention efforts. Gatekeepers are often interested in attracting customers to their 'business' and therefore may be willing to provide ongoing site-based HIV prevention education and materials. On the other hand, exploitative business exchanges contradict ideals of reciprocity and may undermine trust between gatekeepers and drug users impeding harm reduction efforts. Further, being the gatekeeper of a drug use site often accelerates gatekeepers' addictions, making it difficult for them to implement harm reduction strategies.

This article analyzes data on drug injection frequency in a sample of more than 13,000 out-of-treatment drug injectors interviewed across 21 U.S. cities and Puerto Rico through the National Institute on Drug Abuse (NIDA) Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program. The goals of the article are to present findings on injection frequency and to predict variation in terms of a set of variables suggested by previous research, including location, ethnicity, gender, age, educational attainment, years since first use of alcohol and marijuana, income, living arrangement, homelessness, drugs injected, and duration of injection across drugs. Three models were tested. Significant intersite differences were identified in injection frequency, although most of the other predictor variables we tested accounted for little of the variance. Ethnicity and drugs injected, however, were found to be significant. Taken together, location, ethnicity, and type of drug injected provide a configuration that differentiated and (for the variables available for the analysis) best predicted injection frequency. The public health implications of these findings are presented., Key Words: Injection drug users; Injection frequency; Multisite comparison; Ethnicity INTRODUCTION In the years since 1987, AIDS has risen from being the fifteenth to being the eighth most common cause [...]

Drug addicted women whose economic and social base is urban streets face limited options for income generation and multiple dangers of predation, assault, arrest, and illness. Exchanging sex for money or drugs offers one important source of income in this context. Yet the legal, social, and safety risks associated with these exchanges reduce the likelihood of regular safer sex practices during these encounters, thereby increasing the risk of HIV infection. Such conditions lead women engaged in sexual exchanges for money to varied and complex responses influenced by multiple and often contradictory pressures, both personal and contextual. Street-recruited women drug users in an AIDS prevention program in Hartford, Connecticut reported a range of condom use when engaging in sex for money exchanges. This paper explores their differences by ethnicity, economic resources, and drug use, and analyzes these and other factors that impact on street risks through sexual income generation. Surveys and in-depth interviews with drug-addicted women sex workers describe their various approaches to addressing multiple risks on the streets and suggest significant effort by women in these contexts to avoid the many risks, including HIV infection. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]

This paper reports the findings of a study of congruence between AIDS risk perception and risk behavior in a sample of outreach-recruited out-of-treatment injection and non-injection crack cocaine using women in Hartford, CT. While rates of drug- and sex-related AIDS risk were high in this sample, perception of risk was low among many of the respondents. Variation in risk perception reflects sociodemographic differences in the sample, with those women who were most socially isolated exhibiting the greatest incongruence between personal risk and risk perception. Women who have had contact with health or social service programs were the most likely to report reductions in risk behavior. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]

To test the efficacy of culturally targeted acquired immunodeficiency syndrome (AIDS) prevention programs on ethnic minority street drug users, 669 African-American and Puerto Rican drug users were assigned to receive either the National Institute on Drug Abuse (NIDA) standard intervention or a culturally competent enhanced intervention in a quasi-experimental study. The standard intervention was a two-session educational program, while both the African-American and Puerto Rican enhanced interventions provided additional AIDS information in a culturally appropriate fashion. Although human immunodeficiency virus (HIV) risk behaviors, as measured by Bell's risk indices, decreased, there were no meaningful significant differences between interventions. However, participants who went into drug treatment programs showed greater reduction in HIV risk behavior. Cultural interventions may provide better outcome if they concentrate on getting participants into drug treatment., Key Words: Culturally competent interventions; Drug treatment; HIV risk; Injection drug use. Over 100 countries worldwide now report human immunodeficiency virus (HIV) cases associated with drug use (1). As we [...]

A study of drug use locations in Hartford, CT, is designed to understand the environmental and social conditions within 'high risk sites' where drug users inject drugs or smoke crack, in order to develop AIDS prevention models that build upon the physical and social organization of these locations. The study assesses high-risk sites characterized on the basis of type of location or structure, presence and strength of gatekeepers, and presence and strength of HIV prevention opportunities and pressures. A combination of ethnographic, epidemiological, and social network methods are used to document the characteristics, social organization, natural history, and dynamics of these sites, the network relations of site users, and the various opportunities for, or barriers to, on-site social-level HIV prevention intervention. This paper provides an overview of the study and presents preliminary findings, including the degree to which drug injectors and crack smokers use specific types of sites in Hartford. The paper also discusses the ways these findings inform development of on-site, type-specific and peer-led or structural HIV-prevention interventions.

New interventions to reduce HIV and sexually transmitted infections (STI) among female sex workers are introduced into the context of women’s existing prevention beliefs and practices. These indigenous practices affected implementation of our program to introduce female condoms to women in sex-work establishments in southern China. We used ethnographic field observations and in-depth interviews to document common prevention methods women reported using to protect themselves before and during intervention implementation. Individual, sex-work establishment, and other contextual factors, including sources of information and social and economic pressures to use or reject prevention options, shaped their perceptions and selection of these methods and affected adoption of female condoms as an additional tool. Efforts to improve uptake of effective prevention methods among low-income sex workers require attention to the context and spectrum of women’s HIV/STI prevention practices when introducing innovations such as female condoms, microbicides, pre-exposure prophylaxis pills, and others, as they become available. [ABSTRACT FROM AUTHOR]