Casey Borch

Safer Injection Sites in New York City: A Utilization Survey of Injection Drug Users:

HIV, hepatitis B & C, drug overdose, and other drug-related health problems still pose significant health risks to injection drug users (IDUs) and their sexual partners, indicating the need for further development of innovative public health interventions. A relatively new intervention implemented in many municipalities throughout the world is the “safer injection site” (SIS). An SIS is a legal facility that allows people to prepare and inject pre-obtained drugs in a hygienic, anxiety-free atmosphere under the supervision of health personnel. This paper examines the responses of a sample of IDUs in New York City to whether they would use an SIS should one be implemented in mid-town Manhattan. The SIS would be part of a comprehensive harm reduction project that already offers needle-exchange, street outreach, testing and counseling, support groups, referral services including drug treatment, and on-site primary medical and dental services. The results of our study indicate that a large majority of the IDUs sampled would utilize an SIS should one be implemented, and that those most likely to use it are IDUs at the highest risk for contracting or spreading blood-borne diseases such as HIV and hepatitis, and for experiencing a drug overdose.

Power, Embedded Games, and Coalition Formation

ABSTRACT Applications of game theory frequently presume but do not show that social structures contain games. This study shows that multiple games are embedded in strong power structures and that power is exercised because 1) the game of those low in power contains a dilemma whereas 2) the game of those high in power does not. As in previous analyses, we find those low in power play the Prisoners Dilemma game. New to this analysis is the discovery that those high in power play the Privileged game, a game with no dilemma. Also new is the extension of the analysis to the design of coalitions. That extension shows that, when coalition formation succeeds, it eliminates the dilemma of those low in power by transforming their game from Prisoners Dilemma to Privileged. By contrast, exactly the same coalition structure does not alter the game played by those high in power. Applying well-known game theoretic solution concepts, we predict that low power coalitions will countervail power, but that coalitions of those high in power will not affect power exercise. Experiments testing this theory investigate 1) coalitions of those high in power, 2) low power coalitions organized against multiple high power positions, and 3) opposed coalitions struggling for power against each other. Results strongly support the theory.

PEER-DRIVEN INTERVENTIONS IN VIETNAM AND CHINA TO PREVENT HIV: A PILOT STUDY TARGETING INJECTION DRUG USERS

The HIV epidemic in China and Vietnam is on the increase among injection drug users (IDUs). We report on the results of a pilot outreach study in northern Vietnam and southern China to test the feasibility of a peer-driven intervention (PDI) to prevent HIV among IDUs. In the PDI, recruitment relies on a “chain-referral” model in which IDUs carry-out the core outreach activities that salaried outreach-workers/peer-educators traditionally provide. A 6-month follow-up was built into the study design to measure possible changes in IDUs risk behaviors. The impact results of the pilot study are reported bearing on several different measures, such as changes in IDUs rates of lending or borrowing used syringes, willingness to enter into drug treatment, baseline and follow-up recruitment success, and effectiveness of serving as peer-educators in the community. The evidence suggests the PDI is highly feasible and deserving of greater research in both China and Vietnam.

Building a model for solidarity and cohesion using three theories

Drawing on Game Theory, Elementary Theory, and Status Characteristics Theory, this paper offers a theoretical model for a social group that is solidary and cohesive. The group has an economy, a social structure and a cultural structure. Applying Game Theory, economic conditions for solidarity are found. Within those conditions are groups that can be solidary if their social dilemma is resolved. Applying Elementary Theory shows how decentralized norm enforcement solves that social dilemma, but at the cost of second- and higher order free rider problems. Applying Status Characteristics Theory resolves higher order problems. Experiments and ethnographic examples support the analysis.