Kim Radda

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

A study of drug use locations in Hartford, CT, Is designed to understand the environmental and social conditions within “high risk sites” 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 of gatekeepers, and presence and strength of HIV prevention opportunities and pressures. A combination of ethnographic, epidemiological, and social network methods are used to document the characteristics, social organization, natural history, and dynamics of these 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. The paper also discusses the ways these findings Inform development of on-site, type-specific and peer-led or structural HIV-prevention Interventions.

Changing the environment of aids risk: Findings on syringe exchange and pharmacy sales of syringes in Hartford, CT

This paper reports findings from a National Institute on Drug Abuse-funded study designed to test the hypothesis that environmental changes, such as the enactment of laws to increase the accessibility of sterile syringes, including syringe exchange and pharmacy sale of syringes without a prescription, will lower the frequency of HIV risk and the prevalence of HIV among street drug users. Project COPE, a study of AIDS risk and risk prevention, collected longitudinal data on drug use, HIV risk, serostatus, and source of syringes in a sample of 710 out-of-treatment injection drug users in Hartford, CT. Findings support the hypothesis and the growing research-based conclusion that syringe exchange is an effective AIDS risk reduction modality.

Changing Drug Users’ Risk Environments: Peer Health Advocates as Multi-level Community Change Agents

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.

Perceived Environmental Stress, Depression, and Quality of Life in Older, Low Income, Minority Urban Adults

In this chapter we explore the predictors of perceived environmental stress (PES) and depression as indicators of quality of life (QoL) among older adults living in low-income subsidised senior housing in buildings with challenging social environments. We demonstrate that there is considerable variation in the ways that residents of these buildings respond to their environment that are closely linked to their mental health status and their perception of the stressors in their immediate environment. Research has shown substantial effects of environmental stressors on mental and physical well-being, especially among residents of impoverished urban areas (Bullinger, 1989; Eriksson, 1999; Evans, 2003; Feldman and Steptoe, 2004; Garland, 1990; Krause, 1996; Levitt et al., 1987; Shipp and Branch, 1999; Svanborg and Djurfeldt, 1987). These studies present evidence showing that factors including high levels of pollution, low socio-economic status, substandard living conditions, high potential for exposure to violence, limited access to social and health resources, and population density significantly contribute to QoL. In these studies, QoL is measured in a number of ways including indicators of mental and physical health distress. Relationships between contextual factors and these QoL indicators are often non-linear and very complex (Evans, 2003; Krause, 1996). The goal of this chapter is to discuss some of the major factors related to QoL as measured by PES and mental health status, in a sample of older, low-income, minority urban adults from a medium-sized city in north-eastern USA and to explain apparent gender differences.

Sexual culture in low-income older adult housing: norms, behaviours and risks

Abstract This paper explores the behaviours and meanings associated with intimacy and sexuality among older adults with diverse partners living in subsidised senior housing. It utilises survey and qualitative data from a mixed methods of ageing/HIV exposure to illustrate gendered views on sexual and intimate behaviours, and attitudes towards transactional/commercial sex. Data suggest that women were cautious about engaging in intimate relationships, while men sought them and the companionship they provided to address loneliness. Reasons for non-intimacy were age and health problems. Generally speaking, both men and women had positive attitudes towards sex. Men took risks by having multiple partners and using condoms irregularly; women believed they could avoid risks by taking time to get to know their partners, but never used condoms. Forty per cent of men who saw sex workers were not regular condom users. They traded risk of gossip, violence and infection for companionship with women seeking money and physical safety. Findings have implications for policies, counselling and interventions for older sexually active adults in institutional and residential settings.