Migration narratives: expanding methods to examine the interaction of person and environment among aging gay men.

As they age, gay and bisexual men are embedded in multiple environments and communities. This article reanalyzes data collected as part of a larger qualitative study of crystal methamphetamine use in New York City. Focusing on the migration narratives of 30 racially/ethnically diverse men, age 40 years old and older, recruited from multiple venues several key areas emerged: ostracization, lack of affirmation as well as movement activities. Interactively they transformed social practices and increased spaces to explore sexuality, build community engagements and exchange resources. This study suggests that assessment of gay men (and other marginalized groups) may be enhanced through application of migration narratives.

Neighborhood History as a Factor Shaping Syringe Distribution Networks Among Drug Users at a U.S. Syringe Exchange.

Throughout the US, high-visibility drug markets are concentrated in neighborhoods with few economic opportunities, while drug buyers/users are widely dispersed. A study of Pittsburgh Syringe Exchange participants provides data on travel between and network linkages across neighborhoods with different levels of drug activity. There are distinct racial patterns to syringe distribution activity within networks and across neighborhoods. Pittsburgh's history suggests these patterns emerge from historical patterns of social and economic development. Study data demonstrate the ability of IDUs to form long term social ties across racial and geographic boundaries and use them to reduce the risk of HIV transmission.

Reducing non-injection drug use in HIV primary care: A randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement.

AIMS: In HIV-infected individuals, non-injection drug use (NIDU) compromises many health outcomes. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce NIDU is unknown, and drug users may need greater intervention. We designed an enhancement to MI, HealthCall (HC), for daily patient self-monitoring calls to an interactive voice response (IVR) phone system, and provided participants with periodic personalized feedback. To reduce NIDU among HIV primary care patients, we compared the efficacy of MI+HealthCall to MI-only and an educational control condition. DESIGN: Participants age >18 with >4days of NIDU during the prior 30days were recruited from large urban HIV primary care clinics. Of the 240 participants, 83 were randomly assigned to control, 77 to MI-only, and 80 to MI+HC. Counselors provided educational control, MI-only or MI+HC at baseline. At 30 and 60days (end-of-treatment), counselors briefly discussed drug use, moods and health behaviors, using HealthCall-generated graphs with MI+HC patients. Primary outcomes (last 30days) were number of days used primary drug (NumDU), and total quantity of primary drug used (dollar amount spent; QuantU), derived from the Time-Line Follow-Back. FINDINGS: Across all groups, at end-of-treatment, frequency and quantity of NIDU decreased, with significantly greater reductions in the MI-Only group. A twelve-month post-treatment follow-up indicated sustained benefits of MI+HC and MI-only relative to control. CONCLUSIONS: Brief interventions can be successfully used to reduce non-injection drug use in HIV primary care. IVR-based technology may not be sufficiently engaging to be effective. Future studies should investigate mobile technology to deliver a more engaging version of HealthCall to diverse substance abusing populations.

Patterns of sexual commerce among women at US Syringe Exchange Programs.

In the USA, the majority of research on sex work has examined the experiences of women recruited from social locations commonly referred to as the 'sex industry', such as street strolls or escort services. This paper presents data from female syringe exchange participants who had sold sex in the last 30 days. The women interviewed for this study report a much broader array of commercial transactions than found in previous US studies, including selling sex to women, paying men for sex, and considerable role fluidity between buying and selling. In addition, approximately one-third of the women report only selling sex 1 day per week or less, and appear to be more socio-economically stable than women who sell sex more often. We argue that this data suggests the existence of an array of commercial sexual transactions outside of the socially recognized sex industry, and that social location may affect condom use.

Rapid assessment and response studies of injection drug use: knowledge gain, capacity building, and intervention development in a multisite study.

OBJECTIVES: We evaluated the World Health Organization's rapid assessment and response (RAR) method of assessing injection drug use and its associated health problems, focusing on knowledge gain, capacity building, and whether RAR leads to the development of interventions reducing the health effects of injection drug use. METHODS: Data were derived from RAR studies conducted in Beijing, China; Bogotá, Colombia; Greater Rosario, Argentina; Hanoi, Vietnam; Kharkiv, Ukraine; Minsk, Belarus; Nairobi, Kenya; Penang, Malaysia; St. Petersburg, Russia; and Tehran, Iran. RESULTS: Substantial gains in knowledge and response capacity were reported at all of the study sites. Before RAR initiation, prevention and intervention programs had been absent or inadequate at most of the sites. The RARs resulted in many new or modified interventions; 7 sites reported 24 health-related interventions that were subsequently developed and influenced by the RARs. CONCLUSIONS: RARs, which require relatively little external funding, appear to be effective in linking assessment to development of appropriate interventions. The present results add to the evidence that rapid assessment is an important public health tool.