The Transformation of Drug Markets and Its Impact on HIV Outreach to Injection Drug Users in New York City, 1987–2008

Abstract

This oral history describes three periods of street outreach to injection drug users at risk for HIV in New York City: outreach in an era of public drug markets (1987–1993), outreach in an era of private markets (1993–2006), and network-driven outreach (2006–present). Individual interviews with administrators and supervisors of outreach workers are combined with field notes from the ethnographic research experiences of the first two authors to contextualize, compare, and contrast these distinct periods. The combination and triangulation of these sources of data allow for an analysis of both the specific and the wider social and cultural contexts in which outreach intervention efforts were situated. Through these lenses, the article examines some of the reasons why they were or were not successful and discusses prospects for the future.

Keywords :

• New York City
• street outreach intervention
• IDUs, drug markets, and HIV
• self-advocacy

THE AUTHORS

R. Terry Furst, Ph.D., is faculty member of the Anthropology Department at John Jay College of Criminal Justice (City University of New York). His focus over the last two decades has been on ethnographic research on subcultures of drug users, illegal drug markets, sex workers, street drug dealers, the transmission of HIV among IDUs, the evaluation of street outreach intervention workers, the adulteration of heroin in New York City, and the diffusion of heroin in the mid-Hudson region of New York State. His research also includes the evaluation of buprenorphine among opiate-dependent patients.

Ric Curtis, Ph.D., is the Chair of the Anthropology Department at the John Jay College of Criminal Justice. Since 1978, he has conducted ethnographic research in New York City neighborhoods. At the Vera Institute of Justice in the late 1980s, he was coauthor of a study that examined the effectiveness of New York City's TNT. During the 1990s, while at the NDRI, he participated in several large studies of IDUs and HIV risk networks and conducted survey and ethnographic research on risk behaviors among young adults in a neighborhood with high rates of HIV and other sexually transmitted infections. At John Jay College, he was the Director of the “Heroin in the 21st Century” project, a 5-year ethnographic study of heroin users and distributors in New York City, funded by the National Institute of Drug Abuse.

Rebecca Balletto, M.S., received her bachelors’ degree in sociology from the University of Liverpool, England, in 1999 and then relocated to New York City to study criminal justice. She recently graduated from John Jay College of Criminal Justice in New York, where she completed her masters’ thesis evaluating harm reduction and outreach practices to IDUs. She is the recipient of the Claude Hawley Award for best masters’ thesis in the graduate program. Rebecca worked with the Drug Policy Alliance where she assisted in coordinating the 2007 International Drug Policy Reform Conference in New Orleans. She is interested in the substance use and mental health field and hopes to find a career that encourages education and treatment for drug and alcohol dependence.