The world of public health has undergone dramatic changes since the emergence of AIDS in the early 1980s. The appearance and global spread in recent years of wave after wave of new and renewed infectious diseases and their entwinement with each other and with the social conditions and biopsychological consequences of disparity, discrimination, and structural violence has produced a new significant threat to public health internationally. The term syndemic has been introduced recently by medical anthropologists to label the synergistic interaction of two or more coexistent diseases and resultant excess burden of disease. This article provides the fullest examination of this new concept to date, including a review of relevant new literature and recent research finds concerning coinfection and synergistic interaction of diseases and social conditions at the biological and population levels.

A major challenge in the dissemination of evidence-based family interventions (EBFIs) designed to reduce youth substance use and other problem behaviors is effective and sustainable community-based recruitment. This understudied topic is addressed by a preliminary study of 14 community-university partnership teams randomly assigned to an intervention condition in which teams attempted sustained implementation of EBFIs with two cohorts of middle school families. This report describes attendance rates of recruited families maintained over time and across both cohorts, along with exploratory analyses of factors associated with those rates. When compared with community-based recruitment rates in the literature, particularly for multisession interventions, relatively high rates were observed; they averaged 17% across cohorts. Community team functioning (e.g., production of quality team promotional materials) and technical assistance (TA) variables (e.g., effective collaboration with TA, frequency of TA requests) were associated with higher recruitment rates, even after controlling for community and school district contextual influences. Results support the community-university partnership model for recruitment that was implemented in the study.

Background-The study's objective was to examine the effects of "real world," community-based implementation of universal preventive interventions selected from a menu, including effects specific to higher-and lower-risk subsamples.

Increased hepatitis awareness among IDUs is necessary for reducing hepatitis transmissions. Although SEPs continue to effectively disseminate HIV prevention messages-as evidenced by lowered risk behaviors among their customers-they must do more to prevent hepatitis transmissions.

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Efforts have expanded to create AIDS prevention programs for drug users that consider the social context and interpersonal relationships within which risky practices take place. The Risk Avoidance Partnership (RAP) project is designed to train active drug users as "Peer/Public Health Advocates" (PHAs) to bring a structured, peer-led intervention into the sites where they and their drug-using social networks use illicit drugs. The RAP Peer Health Advocacy training curriculum and peer-led intervention promote harm reduction among drug users and support drug-user organization to reduce infectious disease and other harm in the context of injection drug use, crack cocaine use, and sexual activity. Initial findings suggest that RAP PHAs perceive a significant positive role change in themselves while conducting health advocacy work, and willingly and successfully carry the peerled intervention into locations of high-risk drug activity to deliver it to their peers even in the absence of project staff support.

The Risk Avoidance Partnership (RAP) Project conducted in Hartford, Connecticut, tested a program to train active drug injectors and crack cocaine users as “Peer Health Advocates” (PHAs) to deliver a modular HIV, hepatitis, and STI prevention intervention to hard-to-reach drug users in their networks and others in the city. The intervention was designed to diffuse health promotion and risk reduction interventions by supporting PHAs to model prevention practices and deliver risk and harm reduction materials and information. We compared change in behaviors and attitudes between baseline and 6-month follow-up of 112 primarily African American and Latino PHAs, 223 of their drug-network Contact Referrals, and 118 other study recruits (total n=523). Results indicated significant HIV risk reduction among all study participants, associated with significant health advocacy action conducted by PHAs, and a relationship between exposure to the RAP peer-delivered intervention and risk reduction among all study groups. Findings suggest that active drug users' engagement in peer health advocacy can set in motion a feedback and diffusion process that supports both the continued work of the PHAs and the adoption of harm reduction and mimicking of health advocacy by their peers.

Brief universal interventions have potential for public health impact by reducing methamphetamine use among adolescents.