Pedro Mateu-Gelabert

Some data-driven reflections on priorities in AIDS network research.

Risk networks can transmit HIV or other infections; social networks can transmit social influence and thus help shape norms and behaviors. This primarily-theoretical paper starts with a review of network concepts, and then presents data from a New York network study to study patterns of sexual and injection linkages among IDUs and other drug users and nonusers, men who have sex with men, women who have sex with women, other men and other women in a high-risk community and the distribution of HIV, sex at group sex events, and health intravention behaviors in this network. It then discusses how risk network microstructures might influence HIV epidemics and urban vulnerability to epidemics; what social and other forces (such as “Big Events” like wars or ecological disasters) might shape networks and their associated norms, intraventions, practices and behaviors; and how network theory and research have and may continue to contribute to developing interventions against HIV epidemics.

Incarceration, Sex With an STI- or HIV-Infected Partner, and Infection With an STI or HIV in Bushwick, Brooklyn, NY: A Social Network Perspective

OBJECTIVES We examined the link between incarceration and sexually transmitted infection (STI), including HIV, from a social network perspective. METHODS We used data collected during a social network study conducted in Brooklyn, NY (n = 343), to measure associations between incarceration and infection with herpes simplex virus-2, chlamydia, gonorrhea, and syphilis or HIV and sex with an infected partner, adjusting for characteristics of respondents and their sex partners. RESULTS Infection with an STI or HIV was associated with incarceration of less than 1 year (adjusted prevalence ratio [PR] = 1.33; 95% confidence interval [CI] = 1.01, 1.76) and 1 year or longer (adjusted PR = 1.37; 95% CI = 1.08, 1.74). Sex in the past 3 months with an infected partner was associated with sex in the past 3 months with 1 partner (adjusted PR = 1.42; 95% CI = 1.12, 1.79) and with 2 or more partners (adjusted PR = 1.85; 95% CI = 1.43, 2.38) who had ever been incarcerated. CONCLUSIONS The results highlight the need for STI and HIV treatment and prevention for current and former prisoners and provide preliminary evidence to suggest that incarceration may influence STI and HIV, possibly because incarceration increases the risk of sex with infected partners.

Keeping it together: Stigma, response, and perception of risk in relationships between drug injectors and crack smokers, and other community residents

Abstract Sexual relations between drug injectors (IDUs) and crack smokers (CS), and non-drug users are a major means of HIV spread to the broader population. However there is little literature describing community processes that regulate sexual and social partnerships among these groups. We describe these relationships in Bushwick, a low-income, mainly Latino neighbourhood in Brooklyn, NY. In this community, IDU and CS are heavily stigmatized, both by non-users and by some users. Known IDU/CS may find it harder to start and maintain social and sexual relationships, and to get jobs or support. Partially as a result of this stigma, IDU/CS attempt to ‘keep it together’ and hide either their drug use or its extent from other residents. Nevertheless, other residents believe, sometimes falsely, that they can distinguish users from nonusers. We describe some potential negative consequences of these beliefs and interactions, including their effects on risk for HIV and other sexually transmitted diseases.

Street Codes in High School: School as an Educational Deterrent

Elsewhere we have documented how conflict between adolescents in the streets shapes conflict in the schools. Here we consider the impact of street codes on the culture and environment of the schools themselves, and the effect of this culture and on the students’ commitment and determination to participate in their own education. We present the high school experiences of first–generation immigrants and African American students, distinguishing between belief in education and commitment to school. In an environment characterized by ineffective control and nonengaging classes, often students are not socialized around academic values and goals. Students need to develop strategies to remain committed to education while surviving day to day in an unsafe, academically limited school environment. These processes are sometimes seen as minority “resistance” to educational norms. Instead, our data suggest that the nature of the schools in which minority students find themselves has a greater influence on sustaining or dissuading students’ commitment to education than do their immigration status or cultural backgrounds.

School Violence: The Bidirectional Conflict Flow Between Neighborhood and School

In this article we explore the interrelationship between school and neighborhood violence through an ethnographic study conducted over a two‐year period in a New York City middle school. This article presents a bidirectional flow of adolescent conflict by analyzing incidents taking place outside the school that originate in the school setting, and incidents of conflict occurring in the school that were initiated in the surrounding neighborhood. The research shows the effect of school and neighborhood structures on adolescent violence, concluding that school violence is a highly contextual and dynamic process. Adolescents do not choose their fights in a vacuum, but instead, in their selection of peers, allies, and conflict groups, they mirror the organizational and cultural settings of both their school and neighborhood.

Perceptions of drug users regarding hepatitis C screening and care: a qualitative study.

BackgroundIllicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood.MethodsFourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions.ResultsMany drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility.ConclusionDrug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.

Theory, measurement and hard times: some issues for HIV/AIDS research.

Economic and political instability and related “big events” are widespread throughout the globe. Although they sometimes lead to epidemic HIV outbreaks, sometimes they do not—and we do not understand why. Current behavioural theories do not adequately address these processes, and thus cannot provide optimal guidance for effective intervention. Based in part on a critique of our prior “pathways” model of big events, we suggest that cultural–historical activity theory (CHAT) may provide a useful framework for HIV research in this area. Using CHAT concepts, we also suggest a number of areas in which new measures should be developed to make such research possible.ResumenLa inestabilidad económica y política y los “grandes eventos” asociados con ella están muy extendidas en todo el mundo. Los “grandes eventos” a veces conducen a brotes epidémicos de VIH, y a veces no, y no entendemos por qué. Las actuales teorías del comportamiento no abordan adecuadamente estos procesos, y por lo tanto no pueden proveer una óptima orientación para una efectiva intervención. Basándonos en parte en una crítica a nuestro modelo de las “vías” que se interconectan durante los grandes eventos, sugerimos que la Teoría de la Actividad Histórico-Cultural (CHAT en ingles) puede proporcionar un marco útil para la investigación del VIH en esta área. Utilizamos conceptos de CHAT y también sugerimos una serie de áreas en las que las nuevas medidas se deben desarrollar para hacer posible este tipo de investigación.

The staying safe intervention: training people who inject drugs in strategies to avoid injection-related HCV and HIV infection.

This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the interventions two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks.

Volatile Substance Misuse Among High School Students in South America

This article summarizes data from a 2004 study of over 300,000 high school students (aged 13–18 years) in nine South American countries. A probabilistic sample targeted urban secondary schools, utilizing a self-administered questionnaire on prevalence and frequency of substance use. Multivariate analysis showed that volatile substances were the first or second most commonly reported substances used after alcohol and cigarettes in all countries (lifetime prevalence range: 2.67% [Paraguay] to 16.55% [Brazil]). Previous studies have highlighted volatile substance misuse among street children, whereas this study demonstrates that it is common among South American high school students.

Symbiotic Goals and the Prevention of Blood-Borne Viruses Among Injection Drug Users

A positive-deviance control–case life history study of injection drug users (IDUs) in New York City who had injected drugs for 8–15 years compared 21 IDUs who were antibody negative for both HIV and hepatitis C with 3 infected with both viruses and 11 infected with hepatitis C virus but not HIV. Eligible subjects were referred from other research studies and from community organizations that conduct testing for HIV and hepatitis C virus. Data were collected during 2005–2008 and were analyzed using life history and grounded theory approaches. They support grounded hypotheses that IDUs who are able to attain symbiotic goals like avoiding withdrawal and maintaining social support are assisted thereby in remaining uninfected with HIV or hepatitis C. These hypotheses should be tested using cohort studies and prevention trials to see if helping IDUs attain symbiotic goals reduces infection risk. The studys limitations are noted.