The use of qualitative comparative analysis for critical event research in Alcohol and HIV in Mumbai, India.

In this paper we use Qualitative Comparative Analysis (QCA) in critical event analysis to identify under what conditions alcohol is necessary in contributing to unprotected sex. The paper is based on a set of in-depth interviews with 84 men aged 18 = 29 from three typical low income communities in Mumbai who reported using alcohol and having sex with at least one nonspousal partner once or more in the 30 days prior to the interview. The interviews included narratives of critical events defined as recent (past 30-60 day) events involving sexual behavior with or without alcohol.

Spatial dimensions of research on alcohol and sexual risk: a case example from a Mumbai study.

Alcohol's role in unprotected sex is an important issue in the spread of HIV. Research on alcohol use in many countries has found complex relationships between individual characteristics, places where people drink, and consumption patterns. Data on drinking and leisure time activities and locations from in-person surveys with 1,239 young men aged 18-29 living in low-income communities in Mumbai, India, were analyzed.

The effects of husband's alcohol consumption on married women in three low-income areas of Greater Mumbai.

Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men's abusive practices against married women in India is exacerbated by alcohol. The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai. SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk).

Challenges, strategies, and lessons learned from a participatory community intervention study to promote female condoms among rural sex workers in Southern China.

China faces a rapidly emerging HIV epidemic and nationwide resurgence of sexually transmitted infections associated with a growing sex industry. Community empowerment and capacity building through community-based participatory research partnerships show promise for developing, testing, and refining multilevel interventions suited to the local context that are effective and appropriate to address these concerns. However, such efforts are fraught with challenges, both for community collaborators and for researchers.

Multilevel social influences on female condom use and adoption among women in the urban United States.

Heterosexually transmitted HIV remains of critical concern in the United States and around the world, especially among vulnerable and disadvantaged women, complicated by socioeconomic circumstances, gender power, addiction, and experiences of abuse, among other conditions. Effective woman-initiated HIV prevention options, such as the female condom (FC), are needed that women can use in different sexual relationship contexts. We conducted a behavioral and attitudinal survey with 461 primarily African American and Latina (especially Puerto Rican) women in Hartford, Connecticut, to measure factors on the individual, partner relationship, peer, and community levels influencing their initial and continued use of FC (using the prototype FC1) for disease prevention.

Community, culture and sustainability in multilevel dynamic systems intervention science.

This paper addresses intertwined issues in the conceptualization, implementation and evaluation of multilevel dynamic systems intervention science (MDSIS). Interventions are systematically planned, conducted and evaluated social science-based cultural products intercepting the lives of people and institutions in the context of multiple additional events and processes (which also may be referred to as interventions) that may speed, slow or reduce change towards a desired outcome. Multilevel interventions address change efforts at multiple social levels in the hope that effects at each level will forge synergistic links, facilitating movement toward desired change.

Youth Action Research for Prevention: a multi-level intervention designed to increase efficacy and empowerment among urban youth.

Youth Action Research for Prevention (YARP), a federally funded research and demonstration intervention, utilizes youth empowerment as the cornerstone of a multi-level intervention designed to reduce and/or delay onset of drug and sex risk, while increasing individual and collective efficacy and educational expectations. The intervention, located in Hartford Connecticut, served 114 African-Caribbean and Latino high school youth in a community education setting and a matched comparison group of 202 youth from 2001 to 2004. The strategy used in YARP begins with individuals, forges group identity and cohesion, trains youth as a group to use research to understand their community better (formative community ethnography), and then engages them in using the research for social action at multiple levels in community settings (policy, school-based, parental etc.

Multi-level intervention to prevent influenza infections in older low income and minority adults.

In this paper we describe a successful multi-level participatory intervention grounded in principles of individual and group empowerment, and guided by social construction theory. The intervention addressed known and persistent inequities in influenza vaccination among African American and Latino older adults, and associated infections, hospitalizations and mortality. It was designed to increase resident ability to make informed decisions about vaccination, and to build internal and external infrastructure to support sustainability over time.

Building Xperience: a multilevel alcohol and drug prevention intervention.

"Xperience" is an innovative alcohol and drug prevention program that has adopted a multilevel, community-based strategy to promote drug-and-alcohol free social activities, venues and norms among urban youth ages 14-20. The intervention aims to strengthen protective factors and reduce risk factors for alcohol and other substance use among high school age youth by addressing multiple factors at the individual, peer, community and city level. The purpose of this paper is to discuss the process of building the different levels of this intervention during the 3-year formative phase.

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.

Outcomes of a peer HIV prevention program with injection drug and crack users: the Risk Avoidance Partnership.

The Risk Avoidance Partnership (RAP) Project conducted in Hartford, Connecticut, tested a program to train active drug injectors and crack cocaine users as "Peer Health Advocates" (PHAs) to deliver a modular HIV, hepatitis, and STI prevention intervention to hard-to-reach drug users in their networks and others in the city. The intervention was designed to diffuse health promotion and risk-reduction interventions by supporting PHAs to model prevention practices and deliver risk- and harm-reduction materials and information. We compared change in behaviors and attitudes between baseline and 6-month follow-up of 112 primarily African-American and Latino PHAs, 223 of their drug-user network contact referrals, and 118 other study recruits (total n = 523).

The relationship between housing status and HIV risk among active drug users: a qualitative analysis.

This paper examines the relationship between housing status and HIV risk using longitudinal, qualitative data collected in 2004-2005, from a purposeful sample of 65 active drug users in a variety of housed and homeless situations in Hartford, Connecticut. These data were supplemented with observations and in-depth interviews regarding drug use behavior collected in 2001-2005 to evaluate a peer-led HIV prevention intervention. Data reveal differences in social context within and among different housing statuses that affect HIV risk or protective behaviors including the ability to carry drug paraphernalia and HIV prevention materials, the amount of drugs in the immediate environment, access to subsidized and supportive housing, and relationships with those with whom drug users live.

Opportunities for woman-initiated HIV prevention methods among female sex workers in southern China.

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women's knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods.

Unofficial policy: access to housing, housing information and social services among homeless drug users in Hartford, Connecticut.

Background: Much research has shown that the homeless have higher rates of substance abuse problems than housed populations and that substance abuse increases individuals' vulnerability to homelessness. However, the effects of housing policies on drug users' access to housing have been understudied to date. This paper will look at the "unofficial" housing policies that affect drug users' access to housing.

Childhood sexual abuse and HIV risk among crack-using commercial sex workers in San Salvador, El Salvador: a qualitative analysis.

This article explores the relationship between childhood sexual abuse (CSA) and later HIV risk. It draws on qualitative, in-depth interviews with 40 women who either used crack or engaged in commercial sex work in the greater metropolitan area of San Salvador, El Salvador, 28 of whom experienced CSA. Although the relationship between CSA and later HIV risk has been clearly demonstrated, the processes that lead women who have experienced CSA to experience HIV risk are unclear.

Building interdisciplinary/intersectoral research partnerships for community-based mental health research with older minority adults.

Community-based research often brings investigators from different disciplinary backgrounds together with community representatives to conduct research on topics of mutual concern. This paper describes a case example that illustrates an interdisciplinary/intersectoral study of depression and barriers to mental health care among older adults and illustrate the factors central to implementing a successful research partnership. It will address the following conditions that facilitate and challenge interdisciplinary/intersectoral research: (1) achieving commonality of purpose in study design and research and referral approaches; (2) ensuring the ability to develop, field-test and implement psychometrically rigorous and culturally and qualitatively appropriate instruments; (3) building effective management structures for interdisciplinary/intersectoral research partnerships; and (4) identifying, training and supporting qualified researchers to carry out a mental health study with older ethnically diverse adults.

The Risk Avoidance Partnership: Training Active Drug Users as Peer Health Advocates.

Efforts have expanded to create AIDS prevention programs for drug users that consider the social context and interpersonal relationships within which risky practices take place. The Risk Avoidance Partnership (RAP) project is designed to train active drug users as "Peer/Public Health Advocates" (PHAs) to bring a structured, peer-led intervention into the sites where they and their drug-using social networks use illicit drugs. The RAP Peer Health Advocacy training curriculum and peer-led intervention promote harm reduction among drug users and support drug-user organization to reduce infectious disease and other harm in the context of injection drug use, crack cocaine use, and sexual activity.

Times and places: Process evaluation of a peer-led HIV prevention intervention.

Here we present results from a process evaluation of a peer-led HIV prevention intervention. The Risk Avoidance Partnership, conducted from 2001 to 2005, trained active drug users to be peer health advocates (PHAs) to provide harm reduction materials and information to their peers. Results indicate that PHAs actively conducted harm reduction outreach both when partnered with staff and on their own time.

The diffusion of ecstasy through urban youth networks.

Ecstasy is a drug commonly associated with all-night, or all-weekend electronic dance events known as raves. Upper- and middle-class clubs, gay bars and clubs, and party venues are other common public settings where ecstasy use occurs. During the mid to late 1990s its use was reported in locations as distant as Australia and New Zealand, England and Scotland, and North America.

Challenges in measuring concurrency, agency and intentionality in polydrug research.

Polydrug use is of particular interest to researchers concerned with the drug use of youth and young adults because it is associated with progression to regular and addictive drug use. New research shows that polydrug use appears to be taking new forms as youth use multiple drugs concurrently in the same setting, sometimes to achieve specific desired effects. Existing approaches to measuring polydrug use are confusing and inconsistent.

Microbicide acceptability among high-risk urban U.S. women: experiences and perceptions of sexually transmitted HIV prevention.

Objectives: The objectives of this study were to measure microbicide acceptability among high-risk women in Hartford, Connecticut, and contextual factors likely to affect acceptability and use.

Goal: The goal of this study was to assess usefulness of microbicides for HIV/sexually transmitted infection (STI) prevention for high-risk women.

Study: Ethnographic interviews (n = 75) and a survey (n = 471) explored women's perspectives on HIV/STI prevention, vaginal contraceptives similar to microbicides, and microbicide acceptability.

Values and identity: the meaning of work for injection drug users involved in volunteer HIV prevention outreach.

Most HIV behavioral interventions provide participants with preventive information emphasizing how not to behave, and have neglected to provide attractive and feasible alternatives to risky behavior. Interventions that emphasize cultural strengths may have more powerful effects and may help remove the stigma of HIV, which has hampered prevention efforts among African American communities. Starting in 1997, the SHIELD (Self-Help in Eliminating Life-Threatening Diseases) intervention trained injection drug users (N=250) to conduct risk reduction outreach education among their peers.

Hoppers and oldheads: qualitative evaluation of a volunteer AIDS outreach intervention.

Qualitative research can play an important role in explaining outcomes of behavioral interventions and constitutes a largely unrealized potential of ethnographic methods in AIDS research. The Self Help in Eliminating Life Threatening Diseases (SHIELD) intervention trained African American injection drug users to conduct outreach among their drug-using peers and sexual partners. Though the intervention was not targeting adolescents, some participants chose to conduct outreach with youth fortuitously found on the street.

Individual, contextual, and social network factors affecting exposure to HIV/AIDS risk among older residents living in low-income senior housing complexes.

This study examines the influence of individual, contextual (building location and characteristics), and social network characteristics on HIV prevalence and risk behavior among people older than 50 years of age living in low-income senior housing in two cities, Hartford, Connecticut and Chicago, Illinois. The authors' study focuses on older residents of six buildings located in impoverished neighborhoods with high rates of HIV transmission through injection drug use and unprotected sexual activity, including the exchange of sex for drugs and money. The article is organized into three sections.

Assessing human immunodeficiency virus (HIV) risk among older urban adults: a model for community-based research partnership.

Community-based research brings together researchers and community members as partners to conduct research of mutual concern. This article describes the components necessary to implement a successful research partnership, taking as an example a study of human immunodeficiency virus (HIV) risk among residents of senior housing sites in two North American cities. The article describes important aspects of building and sustaining partnerships, the methods implemented to conduct research on sensitive topics, share resources, disseminate results and collaborate on programs and interventions to benefit the health and well-being of older adults.