The Relationship Between Community Structural Characteristics, the Context of Crack Use, and HIV Risk Behaviors in San Salvador, El Salvador

Abstract

This paper explores community structural factors in different low-income communities in the San Salvador, El Salvador, that account for differences in the social context in which crack is used and HIV risk behaviors among crack users. Results suggest that both more distal (type of low-income community, level of violent crime, and poverty) and proximate structural factors (type of site where drugs are used, and whether drugs are used within or outside of community of residence) influence HIV risk behaviors among drug users. Additionally, our results suggest that community structural factors influence the historical and geographic variation in drug use sites

RÉSUMÉ

Le Rapport entre les caractéristiques structurales communautaires, le contexte de l'usage du crack et les comportements à risque pour le VIH à San Salvador, El Salvador

Cet article explore les facteurs structuraux communautaires dans de différentes communautés à bas revenu à San Salvador, El Salvador qui rendent compte des différences dans le contexte social où le crack s'utilise ainsi que dans des comportements à risque pour le VIH parmi les utilisateurs de crack. Les résultats suggèrent que les facteurs structuraux plus distaux (le type de communauté à bas revenu, le niveau de crime violent et la pauvreté) et les facteurs structuraux à proximité (le type de site où les drogues s'utilisent, et si les drogues s'utilisent à l'intérieur ou à l'extérieur de la communauté de résidence) influencent, tous les deux, les comportements à risque pour le VIH parmi les utilisateurs de drogues. En plus, nos résultats suggèrent que les facteurs structuraux communautaires influencent les variations historiques et géographiques des sites où les drogues s'utilisent.

RESUMEN

La relación entre características estructurales de la comunidad, el contexto de consumo de crack y conductas de riesgo del VIH en San Salvador, El Salvador

Este artículo explora los factores estructurales de comunidades de bajos recursos en San Salvador, El Salvador que afectan diferencias en el contexto social en que se consume crack y las conductas de riesgo para VIH entre consumidores de crack. Resultados sugieren que factores estructurales más distantes (tipo de comunidad de bajos recursos, nivel de delincuencia violenta y pobreza) y factores estructurales más cercanos (tipo de lugar donde se consume crack y si se consume crack dentro o fuera de la comunidad de residencia) influyen conductas de riesgo para VIH entre consumidores de crack. Además, nuestros resultados sugieren que factores estructurales de la comunidad influye la variabilidad histórica y geográfica en sitios donde se consumen drogas.

Keywords :

• HIV
• crack
• El Salvador
• structural factors
• neighborhood effects
• drug use sites
• sexual risk
• Latin America

THE AUTHORS

Julia Dickson-Gómez, PhD, is a medical anthropologist and Associate Professor of Psychiatry and Behavioral Medicine at the Center for AIDS Intervention Research, Medical College of Wisconsin. Her research interests include HIV prevention among active drug users in the USA and El Salvador and the influence of structural factors on HIV risk. Previous research interests include the long-term effects of war on families in post-war El Salvador.

Timothy McAuliffe is a biostatistician with particular experience in the evaluation of HIV prevention intervention outcomes. His research at CAIR focuses on the reliability and validity of self-reported risk behavior, and on developing and evaluating novel HIV risk assessment strategies and methods to evaluate the effectiveness of HIV prevention interventions including electronic diary reports for reporting sexual activity. His expertise has led to the development of analytical strategies in HIV prevention trials involving community and social network randomization.

Lorena Rivas de Mendoza, MD, MPH, is Professor/Investigator, Department of Public Health, Universidad Centroamericana José Simeón Cañas, El Salvador. Her areas of interest include HIV/AIDS and violence prevention. As a professor, she has concentrated her teaching activities in the fields of Epidemiology, Biostatistics, Statistical Computing, and Research Methodology applied to public health and the social context. She has participated in both quantitative and qualitative research activities in all the phases of the research projects, but concentrated on quantitative data processing and analyzing. Her work includes developing surveys on health issues of the general population and other specific groups, evaluating a preventing violence –and other risks behavior –program, designing a communication campaign to change behaviors among groups at high risk of HIV/AIDS, such as developing and validating campaign materials, among others.

Laura Glasman, PhD, research explores the motivational and cognitive antecedents of HIV behavior change in different contexts and among diverse populations. Her research also examines strategies that can increase participation in HIV prevention interventions among minorities and in populations where HIV is highly stigmatized. Dr. Glasman has a strong interest in applying meta-analytical methods to understand behavior change, and she has conducted meta-analytic studies to determine how people form attitudes that influence their HIV-related behaviors.

Mauricio Gaborit, PhD (.10 FTE in all years), is a social psychologist with significant research experience in the areas of community violence, gangs, and substance abuse. He is Chair of the Department of Community Psychology at the Universidad Centroamericana. The mission of this graduate program is to address the multiple social problems facing El Salvador including crime and violence, drug abuse, sequelae of the civil war, education for peace and around human rights, and the rights of women and children. The curriculum combines methods and theories from psychology and the social sciences to intervene on a community level. My own work has focused on victims of violence and violence prevention among numerous populations in El Salvador including youth in detention centers.