Values and Identity: The Meaning of Work for Injection Drug Users Involved in Volunteer HIV Prevention Outreach

Abstract

Most HIV behavioral interventions provide participants with preventive information emphasizing how not to behave, and have neglected to provide attractive and feasible alternatives to risky behavior. Interventions that emphasize cultural strengths may have more powerful effects and may help remove the stigma of HIV, which has hampered prevention efforts among African American communities. Starting in 1997, the SHIELD (Self-Help in Eliminating Life-Threatening Diseases) intervention trained injection drug users (N = 250) to conduct risk reduction outreach education among their peers. Many participants saw their outreach as “work,” which gave them a sense of meaning and purpose and motivated them to make other positive changes in their lives.

• Risk behavior
• Risk reduction
• Drug subculture
• Outreach
• Work

Resumen

La mayoría de las intervenciones del comportamiento del VIH le entregan a los participantes información preventiva que acentúa cómo no comportarse pero, a la vez, han descuidado el proporcionar alternativas atractivas y factibles al comportamiento riesgoso. Las intervenciones que enfatizan fuerzas culturales pueden tener efectos de gran alcance y pueden ayudar a quitar el estigma del VIH que ha obstaculizado los esfuerzos de prevención entre las comunidades afro-americanas. Comenzando en 1997, el programa SHIELD (programa de auto-ayuda para la eliminación de enfermedades amenazadoras de la vida) entrenó usuarios de drogas inyectadas (N = 250) para que condujeran una campaña de educación de reducción del riesgo entre sus pares. Muchos participantes vieron el fruto de su búsqueda como “un trabajo”, que les dio un sentido del significado y propósito y los motivó para realizar otros cambios positivos en sus vidas.

Résumé

La plupart des programmes de lutte contre le SIDA, sont basés sur le changement de comportements, et fournissent aux participants des informations préventives en insistant sur les comportements à éviter, tout en oubliant de proposer des alternatives fiables et pratiques. Les programmes qui prennent en compte les aspects culturels sont plus efficaces, car ils peuvent aider à ôter les flétrissures causées par le virus du SIDA qui constituent un handicape aux efforts de prévention menés auprès des Américains d’origine Africaine. Depuis 1997, le program SHIELD (Self Help in Eliminating Life Threatening Diseases) a formé des personnes qui utilisent la drogue par voie intraveneuse (N = 250) à conduire des séances d’éducation auprès de leurs pairs pour réduire les risques d’infection au virus du SIDA. Plusieurs de ces personnes formées par le programme SHIELD considèrent cette activité éducative comme un emploi qui leur procure un sens de mieux-être, du respect, et une motivation pour procéder à d’autres changements dans leurs vies.

Additional information

Notes on contributors

Julia B. Dickson-Gómez

Julia Dickson-Gómez is a medical anthropologist. Her research interests include HIV prevention among active drug users, violence and trauma. She has recently launched a project to study crack use and related sexual risk in El Salvador. Previous research interests include the long-term effects of war on families in post-war El Salvador. She is currently a research associate at the Institute for Community Research in Hartford connecticut.

Amy Knowlton

Dr. Knowlton is on the Faculty of Social and Behavioral Sciences, Department of Health Policy and Management, Johns Hopkins School of Public Health. Her research focuses on social and psychological adaptation to HIV/AIDS, informal HIV caregiving and services utilization among disadvantaged populations affected by epidemic drug use, HIV/AIDS, and other chronic conditions. She has extensive experience in social and behavioural research on inner city drug using populations using both quantitative and qualitative methods. Her research emphasizes social environmental influences on depression and on access and utilization of medical resources among low income injection drug users. Her research has utilized social network methodology to examine the micro-structural basis of opportunities for and costs of social ties that affect health and well-being.

Carl Latkin

Dr. Latkin is an Associate Professor in the Faculty of Social and Behavioral Sciences, Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, with a joint appointment in the Department of Epidemiology. Dr. Larkin is an expert in social network approaches to intervention with drug users and other hard to reach populations. Dr. Latkin was trained as a community psychologist and completed an NIMH postdoctoral fellowship in prevention research. His work focuses on culturally appropriate HIV preventive intervention among inner-city substance users. Dr. Latkin is an expert in the theoretical and methodological application of social network analysis to the examination of social environmental influences on health outcomes among inner city drug using population intervention to various international settings.