African-American Injection Drug Users: Tensions and Barriers in Hiv/Aids Prevention

Abstract

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.

Perceived Barriers to Treatment in a Community-Based Sample of Illicit-Drug-Using African American Men and Women

“…Focusing on those not currently in treatment is vital to develop an accurate understanding of barriers to treatment. Moreover, understanding the need for tailored intervention programs, and having individuals of the same ethnicity, gender, and life experiences, is critical to increasing the amount of African American substance users who utilize treatment (VanderWaal et al 2001). The need for community-specific treatment programs is also critical for engaging African American substance users in treatment.…”

“We Want a Living Solution”: Views of Harm Reduction Programs in Black U.S. Communities

“…Particular stigma surrounding HIV=AIDS and homosexuality within the Black community has been seen as influencing views toward harm reduction programming as well (Beatty et al, 2004;Swanson, Crowther, Greem, & Armstrong, 2004). These dynamics are believed to be largely informed by the legacy and history of U.S. domestic race relations, and seen to inflame a conspiratorial narrative about illicit drugs, HIV=AIDS, and the scientific and medical establishments, such that harm reduction has been seen as merely a way to foster continued drug use and worse (i.e., cultural genocide) within these communities (Anderson, 1991;Gamble, 1997;Thomas & Quinn, 1993;VanderWaal, Washington, Drumm, Terry, McBride, & Finley-Gordon, 2001;Watters, 1996;Woods, 1998).…”

“…Historically, harm reduction has been viewed negatively, intrinsically informed by the stigma surrounding illicit drugs and their link to illness (notably HIV=AIDS) and death within the Black community (Dalton, 1989;VanderWaal et al, 2001;Woods, 1998). Strong moralistic views against illicit drug use and users, the influence of religious doctrine, distrust of government, and political grandstanding have been noted as fomenting community rejection of interventions such as NEP=SEP and methadone (Anderson, 1991;Quimby & Friedman, 1989;Thomas & Quinn, 1993;Watters, 1996;Woods, 1998).…”

“…Wheeler (2009) called for qualitative methods to study the disproportionate HIV=AIDS rates in communities of color, whereas VanderWaal et al (2001) called for researching tension surrounding harm reduction drug services in these communities. Viewed from a certain perspective, a seeming rejection of harm reduction seems self-defeating given the race-based disproportionality in health and illicit drug outcomes, and is of concern.…”

Using GIS to evaluate post-release prisoner services in Newark, New Jersey

“…Public health research regularly finds an association between the spatial distribution (or mismatch) of clients to services and decreased utilization of these services, in both rural and urban areas (e.g., Anderson, 1995;Farley, 2004;Fulcher & Kaukinen, 2005;Nemet & Bailey, 2000;United States General Accounting Office, 1995;VanderWaal et al, 2001;Zenk et al, 2006). Although services in urban areas would seem to be far more available compared to rural communities, proximity alone does not facilitate or predict use.…”