Illicit drug use remains a significant public health threat. The issues surrounding drug use are recognized by public health professionals as important for several reasons. The incidence and prevalence of drug use persists in spite of the extensive societal, interpersonal, and individual consequences. In addition, the chronic health issues and health care costs associated with drug use continue to spiral. A wide variety of quantitative studies have examined the extent of health care problems, access, cost, and health care satisfaction among illicit drug users. While these studies offer important information through survey formats, fewer studies focus on subjective constructions of health care management from the users' perspective. This article examines the elements of the decision-making process involved in accessing formal health care among chronic and injecting street drug users. Twenty-eight in-depth interviews provide the data for this analysis, which is part of a large quantitative study of 1,479 injecting and chronic drug users and nondrug users in Miami, Florida. By exploring the elements of health care access through the eyes of the drug users, researchers and treatment professionals may gain insights into new ways to improve health care access for this at-risk population.

This qualitative study analyzes data from in-depth interviews to describe self-care strategies among chronic and injecting drug users. While the types of strategies varied from participant to participant, the theme of proactive self-care remained strong throughout the data. Researchers identified five self-care domains discussed by the study participants. The self-care domains include strategies to improve nutrition, increase physical activity, address medical concerns, regulate substance use, and reduce sexual risk. Overall, these data indicate that chronic drug users are actively involved in managing and improving their health and attempt to take self-protective actions, even while continuing to engage in active drug use. These findings are particularly relevant for primary care providers, walk-in clinics, drug treatment programs, outreach workers and those engaged in harm reduction efforts. Recognizing that drug users are actively involved in taking care of their health can be an important strategy to build into any intervention or risk reduction program.

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The Adventist Development and Relief Agency (ADRA) is a nongovernmental organization that provides community development and disaster relief services in 120 countries around the world. ADRA is an agency of the Seventh-day Adventist Church, a Christian North American-based religious denomination that operates an international system of hospitals, clinics, schools, universities and human service programs (). Consistent with its non-pro®t status, ADRA employs and offers services to people without regard to age, ethnicity or political or religious af®liation. ADRA's services, which are provided to approximately 19 million people per year, include food security, economic development, primary health, disaster response and basic education programs (ADRA International, 2000: 3). The agency has a humanitarian and developmental philosophy of service rooted in the belief system of the Seventh-day Adventist Church. However, the mission statement of the agency and its annual report seem to support the claim that its purpose is not to engage in proselytism. The agency's high degree of administrative and ®nancial independence from the church also seems to support this claim. In 1999, only 7 percent of

This article offers findings from qualitative needs assessment of Kosovar refugees in south Albania at approximately one month following their flight from Kosovo (May, 1999). Common themes emerged from the interview data including trauma and the desire for emotional help, lack of information about loved ones, and the need for activities and self-determination in the camps. Framing these findings within an ecological model of human development, we propose a comprehensive approach to social work interventions in refugee camps. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH.

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This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.