Findings from the Horizontes Acquired Immune Deficiency Syndrome Education Project: The Impact of Indigenous Outreach Workers as Change Agents for Injection Drug Users

Abstract

A human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) intervention using indigenous outreach workers was implemented with Hispanic injection drug users (IDUs) and their sexual partners in three locations: Laredo, Texas; San Diego, California; and San Juan, Puerto Rico. A total of 2,169 subjects were contacted, given health education, HIV antibody testing, and follow-up counseling. This article reports on the 1,616 IDUs (75%) who completed the initial and follow-up interviews. The results indicated significant increases in health knowledge on AIDS, decreases in needle risk drug taking behaviors, some decreases in sex risk behaviors, and more realistic perceptions of personal AIDS risk. Using multivariate analyses, gender (male) and increasing age (older than age 25 years) were the strongest predictors of behavior change. Surprisingly, the identification of a positive HIV serostatus was not a significant predictor of behavior change. Although intended as a comparison study between contrasting levels of intervention, logistical and administrative problems undermined the use of a true quasi-experimental design. Nonetheless, the results from this research suggest that the use of indigenous outreach workers is an effective means of combatting the spread of HIV in this difficult to reach population. Some programmatic recommendations are provided for future efforts of this kind, particularly in relation to role conflicts experienced by outreach workers.

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References

Marin B. : Hispanic cultures: Implication for AIDS prevention in sexuality and disease , in Boswell J , Hexter R , Reinisch R (eds.): Metaphors, Perception and Behavior.

Friedman SR , Sotheran J. , Abdul-Quader A. , Primm B. , Des Jarlais DC , Kleinman P. , Mauge C. , Goldsmith D. , El-Sadr W. , Malansky R. : The AIDS epidemic among Blacks and Hispanics. Milbank Q 65:455-499, 1987 (Suppl. 2).

Bakeman R. , Lumb J. , McCray, E, Jackson R. , Whitley P. : The incidence of AIDS among Blacks and Hispanics . J Nat Med Assoc 18:25-38, 1988.

DiClemente R. , Boyer C. , Morales E. : Target groups for preventing AIDS among intravenous drug users. J Appl Soc Psychol 17:251-268, 1990.

Conviser R. , Rutledge JH : The need for innovation to halt AIDS among intravenous drug users and their sexual partners. AIDS Public Policy 3:43-50, 1988.

Hughes P. : Behind the Wall of Respect: Community Experiments in Heroin Addiction Control . Chicago, IL, University of Chicago Press, 1977.

National Institute of Drug Abuse : Coding manual for SPSS data entry for AIDS initial assessment questionnaire. Rockville, MD, National Institute of Drug Abuse, 1989.

Meyers M. , Snyder F. , Bryant E. , Young P. : Report on reliability of the AIDS initial assessment questionnaire (contract no. 271-88-8231). Bethesda, MD, National Institute of Drug Abuse, 1990.

Catan V. , Des Jarlais DC , Friedman SR , Marmour S. : Psychosocial influences on risk behavior and immunity. Paper presented at the American Psychological Association National Convention , San Francisco, CA, August 18, 1991 .

10.

The Koba Institute : AIDS risk reduction through indigenous outreach programs: Final report to the National Institute of Drug Abuse. Washington, DC, Koba Institute, December 1991.

11.

Schneider D. , Laurette T. , Prater L. , Wright M. : Risk assessment for HIV infection: Validation study of a computer-assisted preliminary screen . AIDS Educ Prev 3:215-229, 1991.

12.

Centers for Disease Control : Continuing increase in infectious syphilis—United States. MMWR 37:35-37, 1988.

13.

Albee G. : Introduction in Mays V , Albee G , Schneider S (eds.): Primary Prevention of AIDS: Psychological Approaches. Newbury Park, CA, Sage Publications, 1989.

14.

Institute of Medicine : Confronting AIDS: Update 1988. Washington, DC, National Academy Press, 1989.

15.

National Research Council : ADIS, sexual behavior and intravenous drug use. Washington, DC, National Academy Press, 1989 .