Changing Drug Users' Risk Environments: Peer Health Advocates as Multi‐level Community Change Agents

Abstract

Peer delivered, social oriented HIV prevention intervention designs are increasingly popular for addressing broader contexts of health risk beyond a focus on individual factors. Such interventions have the potential to affect multiple social levels of risk and change, including at the individual, network, and community levels, and reflect social ecological principles of interaction across social levels over time. The iterative and feedback dynamic generated by this multi-level effect increases the likelihood for sustained health improvement initiated by those trained to deliver the peer intervention. The Risk Avoidance Partnership (RAP), conducted with heroin and cocaine/crack users in Hartford, Connecticut, exemplified this intervention design and illustrated the multi-level effect on drug users' risk and harm reduction at the individual level, the social network level, and the larger community level. Implications of the RAP program for designing effective prevention programs and for analyzing long-term change to reduce HIV transmission among high-risk groups are discussed from this ecological and multi-level intervention perspective.

Ethics of Social Media Research: Common Concerns and Practical Considerations

“…Courts have held, for example, that an individual generally has a reasonable expectation of privacy within his or her own home, but does not have a reasonable expectation of privacy in things the individual knowingly exposes to the public. 19 The right to privacy is similarly recognized in civil cases between nongovernmental parties. A defendant can be liable, for example, when he or she makes public disclosures of private facts about the plaintiff.…”

Social psychological dynamics of enhanced HIV risk reduction among peer interventionists

“…Peer-delivered interventions increasingly have been advocated to reduce human immunodeficiency virus (HIV) risk among hard to reach populations, such as active drug users, men who have sex with men (MSM), and youth (Broadhead, Heckathorn, Grund, Stern, & Anthony, 1995; Latkin, Sherman, & Knowlton, 2003; Sikkema et al, 1996; Weeks et al, 2009). Such interventions are thought to provide many advantages to other intervention strategies, such as small group or individual cognitive–behavioral interventions because of their ability to reach hidden populations and their relative cost-effectiveness (Broadhead et al, 1995; Dickson-Gomez, Weeks, Martinez, & Convey, 2006).…”

“…In addition, peer-delivered interventions may be more acceptable to marginalized populations such as drug users, who are often mistrustful of health care professionals because they are delivered by individuals who are behaviorally and ethnically similar and draw on people’s intrinsic motivations to help others in their same circumstances (Broadhead et al, 1995; Friedman et al, 2004; Kelley, Murphy, & Lune, 2001; Latkin, 1998; Latkin, Hua, & Tobin, 2003; Weeks, Dickson-Gomez, Mosack et al, 2006). Indeed, many studies have found peer interventionists to be extremely effective at reaching hidden populations, and delivering prevention materials and messages (Amirkhanian, Kelly, Kabakchieva, McAuliffe, & Vassileva, 2003; Dickson-Gomez et al, 2006; French, Power, & Mitchell, 2000; Ross, Harzke, Scott, McCann, & Kelley, 2006; Simons et al, 1996; Van Khoat, West, Valdiserri, & Phan, 2003; Weeks et al, 2009). …”

“…While using the rules of etiquette and social support common in friendship groups, these interventions are unlikely to move beyond the social network level. Finally, other peer-delivered social network interventions offer opportunities for change at multiple levels including individual behavior change, social network change, and larger community level as actions by a large cadre of trained peer interventionists and support from their peers create a social movement to improve the health of the targeted population (Kelly, 2004; Weeks et al, 2009). These train large numbers of the target population to be peer educators to others in their networks and among crack users in the community (Kelly, 2004; Latkin, Sherman et al, 2003; Weeks et al, 2009).…”

Societal, policy and academic ‘visions’ for the future of the marine environment and its management, exemplified in the Northern and Western Isles of Scotland.

“…They have been identified as key to creating effective change where problems are complex and culturally imbedded because of their ability to understand the barriers and envision routes through them (Peterson 2014;Wiggins et al 2013). Much of the research on AfC is confined to subject areas including healthcare (Weeks et al 2009;Wiggins et al 2013), education (Hargreaves 2005;Peterson 2014), gender studies (Bjørnholt 2011;Peterson 2014; UK Government Equalities Office 2014), rural entrepreneurship (Grodofsky and Soffer 2011;Korsching and Roelfs 2005;Waddock and Post 1991), and organisational management (Vermeulen et al 2010;Bucciarelli 2015). However, research is emerging showing their importance to rural community development, with particular reference to facilitating renewable energy (RE) development in peripheral regions (Graziano et al 2016;Rennie and Billing 2015).…”