High Risk Drug Use Sites, Meaning and Practice: Implications for AidS Prevention

Abstract

A study of drug use locations In Hartford, CT, Is designed to understand the environmental and social conditions within ·hlgh risk sues"where drug users inject drugs or smoke crack, In order to develop AIDS preventIon models that build upon the physical and social organization of these locations. The study assesses high-risk sites characterized on the basis of type of location or structure, presence and strength ofgatekeepers, and presence and strength of HIV prevention opportunities and pressures. A combInation of ethnographic, epidemiological, and social network methods ara used to document the characteristics, social organization, natural history, and dynamics ofthese sites, the network relations of site users, and the various opportunitIes for, or barriers to, on-site social-level HIV prevention Intervention. This paper provides an overview of the study and presents preliminary findings, Including the degree to which drug injectors and crack smokers use specific types of sites In Hartford. Thepaperalso discusses the ways these findings Inform development ofon-site, type-specific and peer-led or structural HIV-pravention Interventions.The AIDS epidemic among impoverished, urban drug users presents unique challenges to health researchers, treatment providers, and policy makers.

Exploration of a Crack Use Setting and Its Impact on Drug Users’ Risky Drug Use and Sexual Behaviors: The Case ofPiaulesin a Montréal Neighborhood

“…In regards to specific drug use settings such as crack houses and shooting galleries, some authors have highlighted the potential to conduct interventions where gatekeepers could act as providers of harm reduction materials and information (Weeks et al, 2001;Dickson-Gomez et al, 2004;Dickson-Gomez et al, 2007). While this strategy is innovative and feasible in some parts of the world, its potential is limited in Hochelaga-Maisonneuve piaules.…”

“…Drug use settings, which are both geospatially and socially defined, have been shown to influence risky sex and drug use behaviors. (Rhodes, 2002;Rhodes et al 2005;Dickson-Gomez et al, 2007;Weeks et al, 2001). In this perspective, the study of crack houses as sale and consumption settings enhances understanding of the contexts that foster risk-taking among crack smokers and the people around them.…”

“…Despite this variability, the most common definition of crack house is an established site where crack users gather to smoke crack, socialize and engage in sexual activities (Ratner, 1993;Weeks et al, 2001). Previous ethnographic studies of crack houses have revealed significant elements that enhance understanding of the social contexts of risky behaviors associated with crack use (Ratner, 1993;Inciardi, 1993;Bourgois & Dunlap, 1993;Weeks et al, 2001). These behaviors revolve mainly around "sex-for-crack exchanges" which are often prevalent in crack houses.…”

“…Studies have shown that sexual activities in crack houses tend to be anonymous, frequent, uninhibited and often unprotected (Carlson & Siegal, 1991;Ratner, 1993;Williams, 1993;Inciardi, 1995). Women who engage in sex-for-crack exchanges in crack houses are highly vulnerable: they are sexually exploited and often victims of violence and rape (Inciardi, 1993;Weeks et al 2001;Sharpe, 2005).…”

Neighborhood Differences in Patterns of Syringe Access, Use, and Discard Among Injection Drug Users: Implications for HIV Outreach and Prevention Education

“…2,3,26 Bluthenthal and coworkers 4 likewise found that publicly accessible shooting galleries were not present in the relatively more affluent Fruitvale neighborhood in contrast to the poorer West Oakland neighborhood of Oakland, California.…”