Training Drug Treatment Patients to Conduct Peer-Based HIV Outreach: An Ethnographic Perspective on Peers' Experiences

Abstract

From 2005 to 2008, the Bienvenidos Project trained Puerto Rican patients of New York City and New Jersey Methadone Maintenance Treatment Programs to conduct peer-based community outreach to migrant Puerto Rican drug users to reduce migrants’ HIV risk behaviors. Ethnographic research, including focus groups, individual interviews, and observations, was conducted with a subset of the patients trained as peers (n == 49; 67%% male; mean age 40.3 years) to evaluate the self-perceived effects of the intervention. Results of the ethnographic component of this study are summarized. The role of ethnographic methods in implementing and evaluating this kind of intervention is also discussed.

RÉSUMÉ

Malades de Traitement de Drogue d’entraînement pour Diriger l’Assistance de VIH Pair-Basé: Une Perspective d’Ethnographic sur les Pairs’ Eprouve

De 2005 à 2008, le Projet de Bienvenidos a entraîné les malades de Ricien de Porto de Ville de New York et de Nouveau Jersey MMTPs pour diriger l’assistance de communauté pair-basé aux utilisateurs de drogue de Ricien de Porto saisonniers pour réduire des migrants les comportements de risque de VIH. La recherche d’Ethnographic, y compris les groupes de foyer, les entretiens d’individu et les observations, a été dirigée avec un sous-ensemble des malades entraînés comme scrute (n == 49; 67%% mâle; signifier vieillir 40,3 ans) évaluer l’a perçu automatiquement des effets de l’intervention. Les résultats du composant d’ethnographic de cette étude sont résumés. Le rôle de méthodes d’ethnographic dans exécuter et évaluer ce type d’intervention est aussi discuté.

RESUMEN

El Tratamiento de la Droga de la instrucción Pacientes para Realizar Alcance Igual-Basado de VIH: Una Perspectiva Etnográfica en Iguales’ Experimenta

Del 2005 al 2008, el Proyecto Bienvenidos adiestró pacientes Puertorriqueños/as matriculados/as en programas de metadona en Nueva York y en Nueva Jersey como “pares.” Estos/as estarían a cargo de llevar a cabo el trabajo de alcance en la comunidad de inyectores/as de drogas recientemente inmigrados/as de Puerto Rico con el objetivo de reducir sus conductas de riesgo asociadas con VIH/SIDA. Investigación etnográfica, incluyendo grupos focales, entrevistas individuales y observaciones, fueron hechas con un grupo de estos/as pacientes adiestrados/as como “pares” (n == 49; 67%% hombres; edad media 40.3 años) para evaluar sus percepciones en torno a los efectos de la intervención. Los resultados del componente etnográfico aparecen aquí resumidos. El rol de los métodos etnográficos para implementar y evaluar este tipo de intervención también es discutido en esta publicación.

Keywords :

• peer outreach
• HIV prevention
• methadone maintenance treatment
• ethnography
• qualitative evaluation
• intervention evaluation

THE AUTHORS

Honoria Guarino, Ph.D., is a Project Director at National Development and Research Institutes. Since 2004, she has managed several research projects evaluating computer-based behavioral health interventions, including projects evaluating substance abuse treatment interventions for adults in methadone maintenance treatment and an HIV and disease prevention intervention for adolescents in substance abuse treatment. She has also worked as an ethnographer for the Bienvenidos study which implemented and evaluated a peer-based HIV prevention intervention for Puerto Rican migrant drug users. Dr. Guarino received her Ph.D. in Anthropology from the University of Arizona in 2003. Her current research interests include qualitative research methods, ethnography and young Russian-American opioid users in New York City.

Sherry Deren, Ph.D., is the Director of the Center for Drug Use and HIV Research (CDUHR) at National Development and Research Institutes, Inc. (NDRI) in NYC. Dr. Deren has been Principal Investigator for many NIDA-funded research projects related to drug use and HIV. She is currently the principal investigator of an intervention study developed to reduce HIV risk behaviors of migrant drug users from Puerto Rico. In addition, as Director of CDUHR, a NIDA-funded P30 Research Center focused on the socio-behavioral study of drug use-HIV/AIDS, she oversees a research infrastructure for over 25 research projects at NDRI and affiliated institutions. She is also the cofounder of the New York HIV Research Centers Consortium, comprised over 20 HIV research Centers in the New York tri-State area. She has served on NIH research review committees, is vice-chair of the Scientific Advisory Committee for amfAR and is the author of many articles on HIV/AIDS prevention among high-risk substance users.

Milton Mino was project director of the study described in this paper. He has managed several large drug-use and health-related research intervention studies, including those on adolescents and criminal justice populations, using both quantitative and qualitative methodologies. He has authored reports aimed at scientific audiences as well as policy makers and drug treatment providers and is currently Assistant Director of Research at New York University's College of Nursing.

Sung-Yeon Kang, Ph.D., has worked as a researcher and is currently a principal investigator at the National Development and Research Institutes, Inc., New York City. In the last 20 years, Dr. Kang has been involved in a wide variety of projects funded by the National Institute on Drug Abuse and other agencies. These projects have focused on drug abuse and related problems, such as HIV/AIDS, psychological status, criminal involvement, and other public health issues. Her numerous published articles include topics on HIV/AIDS risk behaviors and networks among Puerto Rican drug users, HIV risks among incarcerated populations, evaluation of drug treatment, and the validity of self-reported drug use. Her current research interest is to identify factors that are associated with gender differences in healthcare and drug treatment utilization.

Michele G. Shedlin, Ph.D., professor, NYU College of Nursing, is a medical anthropologist with extensive experience in reproductive health, substance abuse, and HIV/AIDS research in Latin America and the US. She has designed and implemented behavioral studies and qualitative research training at the community, university and national levels, to inform and evaluate prevention and care. Dr. Shedlin is currently involved in NIH-funded research on HIV risk for Colombian refugees in Ecuador, ARV adherence among US-Mexico border populations, and post-Katrina Latino migrant workers in New Orleans. She maintains adjunct faculty appointments at Columbia University, the University of Texas School of Public Health, University of Texas at El Paso and the University of Connecticut. Her recent publications report results of research on Latino immigrant groups in the United States and drug use and HIV risk in Nicaragua.

Notes

1 In order to preserve participants’ confidentiality, all names have been changed.