Drug Users versus Outreach Workers in Combating Aids: Preliminary Results of a Peer-Driven Intervention

Abstract

AIDS prevention efforts for injection drug users (IDUs) since 1988 in over 60 inner-city areas within the United States have been based on a “provider-client” model called “street-based outreach.” We document the research showing that these traditional outreach projects operate under conditions that cause hierarchy and supervision to break down easily. The result is an array of organizational problems that push outreach projects toward inertia, and invite high levels of mal- and nonperformance by outreach workers (OWs) as rational adaptations to their work conditions. Nevertheless, research has also documented that IDUs responded very impressively to the outreach services they received. Based on IDUs' responsiveness, we outline the operational features of a “Peer-Driven Intervention” (PDI) that relies on an active collaboration with IDUs in place of a “provider-client” model. Based on a comparative study in eastern Connecticut, we present preliminary impact data comparing the effectiveness of a PDI with a traditional outreach intervention in terms of recruitment power, educational effectiveness of IDUs in the community, and comparative intervention costs.

An External Evaluation of a Peer-Run "Unsanctioned" Syringe Exchange Program

“…While it is likely that the extended hours played a major role in reaching the highest risk IDUs, previous studies have shown that user-run services may greatly extend the reach of traditional service provider/client models of service delivery. 14,35 The use of public spaces for drug use is responsible for public nuisance, unsafe disposal of syringes and has been cited among the greatest concerns of residents and businesspersons in neighborhoods where public drug use is common. 16,20,34,36 While the provision of syringes from an outdoor table may play a beneficial public health role, interventions aimed at balancing public order and public health are clearly needed in these circumstances.…”

A comparison of network sampling designs for a hidden population of drug users: Random walk vs. respondent-driven sampling

“…First, RDS may improve recruitment efficiency. Since each staff recruiter can give coupons to many peer recruiters, the sample can be generated quickly and relatively cheaply (Broadhead, et al, 1995, Heckathorn, 1997. Second, peer recruiters generally will have greater access to the hidden population and its subpopulations than will a staff recruiter.…”

“…Newer, network-based sampling methods also allow the researcher to sample from a hidden population (Heckathorn, 1997, Klovdahl, 1985, Klovdahl, 1989, Klovdahl, et al, 1994, Spreen, 1992. Two designs, the random walk (Klovdahl, 1989, Klovdahl, 1990, Liebow, et al, 1995 and respondent-driven sampling (Broadhead, et al, 1995, Heckathorn, 1997, take advantage of social networks within a population and aim to avoid some biases of earlier sampling methods. Appropriate analysis may allow the researcher to minimize biases associated with a given design in order to improve the estimate of population parameters (Gile and Handcock, 2011, Heckathorn, 2007, Thompson, 2011.…”

The Relationship Between Discrimination and High-Risk Social Ties by Race/Ethnicity: Examining Social Pathways of HIV Risk

“…28 In brief, neighborhoods that were ethnographically mapped as high drug active areas in New York City were targeted and RDS, a chain sampling referral strategy, was employed to reach drug users who were harder to reach. 29,30 Study Design START employed two study designs: (1) a prospective study design among heavy non-IDUs who never injected and used heroin, crack, or cocaine (i.e., used ≥1 year and currently used ≥2-3 times per week in the past 3 months) and (2) a crosssectional study design among recently initiated IDUs (i.e., injected for ≤4 years and currently injected ≥1 in the past 6 months). Drug use was verified with a rapid drug test that detected opiate and cocaine metabolites in the urine.…”