High Risk Crack Use Settings and HIV in El Salvador

Research Method: Basic Research

Principal Investigators: Julia Dickson-Gomez, Ph.D., Principal Investigator;

Margaret Weeks, Ph.D., Co-Principal Investigator; Mauricio Gaborit, Ph.D., Co-Principal Investigator; Ernesto Alfonso Selva-Sutter, Ph.D., Co-Investigator

Grant: National Institute on Drug Abuse R01 DA 020350

Partners: Fundación Antidrogas de El Salvador (FUNDASALVA); Universidad Centroamericana José Simeon Cañas

In collaboration with local partners and communities, this four-year study will combine qualitative and quantitative research methods to examine the intersection of community structural factors, the micro-social context of crack use and sales, and HIV risk among crack users in metropolitan San Salvador. In the project’s first phase, staff will conduct community observations, focus groups and in-depth interviews in nine communities. The ethnographic findings will be presented to residents and advisory/working groups formed in each of the nine communities. The formative  research will inform the development of a quantitative survey during the second phase that will be administered to 540 crack smokers including a follow-up interview after 6 months. In the final phase of the project, staff will collaborate with the community advisory/working groups to develop a multi-level intervention that will be tested for acceptability and feasibility through focus groups with community leaders and crack users. 

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Longitudinal Study of the RAP Peer Intervention for HIV Prevention
Research Method: Intervention
Principal Investigator: Margaret R. Weeks, PhD.
Grant: National Institute on Drug Abuse (NIDA) 1 R01 DA13356
Partners: Community residents (Peer Health Advocates)
Dates of Study: 2005-2008

Project Summary
This 3-year study is a continuation of ICR's Risk Avoidance Partnership (RAP), a peer-delivered intervention study that trained active injection drug users (IDUs) and crack cocaine users to disseminate prevention messages and materials to their drug and sex risk networks at drug-use and community sites. The Longitudinal Study of the RAP Peer Intervention for HIV Prevention will continue to evaluate RAP by assessing: the long-term effects of the Peer Health Advocate (PHA) training program and intervention on HIV risk reduction attitudes and behaviors among PHAs, their drug using networks and the larger drug using community in Hartford, CT; and the factors that will successfully sustain the intervention over time. The project's integration of qualitative and quantitative methods includes re-interviewing trainees from the original study and their contacts with a risk behavior and health attitudes survey, continued observation of drug use sites, periodic in-depth interviews with PHAs and their drug using peers, and a community-wide survey of 500 members of Hartford's drug using population during the project's third year.
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Sustained Safer Behavior (Female Condom Use) in High-Risk Women to Prevent HIV

Research Method:  Basic Research

Principal Investigator:  Margaret R. Weeks, PhD

Grant:  National Institute for Mental Health (NIMH) RO1 MH069088-01A2

Dates of Study:  2004-2007

Project Summary

This 4-year study explores the factors that facilitate or impede female condom use among high-risk urban women, particularly whether participants continue using the female condom after initial barriers (lack of free or low-cost access and information) have been reduced. In Hartford, CT, project staff will conduct a behavioral and attitudinal survey with 575 women at 3 points in time regarding their HIV risk and prevention efforts, as well as their expectations and experiences with female and male condoms. We also will explore the experiences and perspectives of 75 women and their male partners who try the female condom together for 2 weeks.

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Crack Use and Related Sexual Risk in El Salvador
Research Method: Basic Research
Principal Investigator: Julia Dickson-Gomez, Ph.D.
Grant: Center for Interdisciplinary Research on AIDS, Yale University, through the National Institutes of Mental Health (P30 MH 62294)
Partners: Fundación Antidrogas de El Salvador (FUNDASALVA); Universidad Centroamericana José Simeon Cañas

Dates of Study: 2002-2005

Project Summary

This pilot study used qualitative in-depth interviews with 23 crack smoking women and 15 crack smoking men in the greater metropolitan area of San Salvador, El Salvador to investigate the relationship between crack use and high-risk sexual behaviors. A smaller sample of 20 female sex workers was also interviewed to determine different pathways into drug use and in HIV risk behaviors. Findings will be used to identify components of an HIV risk reduction intervention for these populations, which are particularly vulnerable to contracting HIV.

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Microbicide and Female Condom Acceptability for HIV/STD Prevention Among Female Sex Workers in Southern China
Research Method: Basic Research
Principal Investigators: Margaret R. Weeks, Ph.D., PI (ICR), Susu Liao, Ph.D., Co-PI (Peking Union Medical College)
Grant: Fogarty International Research Collaboration Award for HIV-AIDS
Partners: Department of Epidemiology, Peking Union Medical College (PUMC), Chinese Academy of Medical Sciences (CAMS)
Dates of Study: 2003-2006
This three-year study is a supplement to ICR's "Microbicide Acceptability to Prevent HIV in High-Risk Women". The focus of the study is to replicate some aspects of the Microbicide Acceptability project in three rural and semi-urban towns in Hainan and Guangxi Provinces in China. The study will work with local health care providers or other trusted community workers to examine the level of preparedness among female sex workers for using microbicide products and the female condom for HIV/STD prevention. The study will use both qualitative and quantitative methods to examine factors that affect their willingness to try or adopt such methods, and their reasons for choosing among alternative approaches to reducing HIV/STDs.
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Housing Status/Stability and HIV Risk Among Drug Users

Research Method: Basic Research
Principal Investigators: Julia Dickson-Gomez, Ph.D., (PI), Margaret R. Weeks, Ph.D., (Co-PI)

Grant: National Institute on Drug Abuse

Dates of Study: 2004-2005

The role of structural factors in HIV prevention research with drug users requires further study. An area that may have significant impact on the context in which drug and sex-related HIV risk occurs, is housing status and the role of housing policies in limiting drug users' access to stable housing. This study uses qualitative research to examine the relationship between housing policy, neighborhood characteristics, and personal factors that affect drug users' housing status and stability, and the relationship between housing status and stability and HIV risk.

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International Initiatives to Prevent HIV/STD Infection

Research Method: Basic Research, Intervention Research

Principal Investigators: Stephen L. Schensul, Ph.D., University of Connecticut School of Medicine, (PI); Bonnie K. Nastasi, Ph.D., ICR (Co-PI), Dr. Ravi Verma, Population Council, New Delhi, India (Co-PI); Drs. T. K. Roy, G. Rama Rao, & N. Saggurti, International Institute for Population Studies, Mumbai, India (Co-PIs).
Grant: National Institute of Mental Health

Partners: University of Connecticut School of Medicine, International Institute for Population Studies (Mumbai, India)

Dates of Study: 2002-2007

HIV/STD rates in India are increasing at a dramatic rate, causing health officials and national policy makers to seek new approaches to prevention and treatment. This study addresses the difficulty encountered in trying to engage males in reproductive health education, sexual risk and early HIV/STD treatment in three urban communities in Mumbai, India. The project is testing an intervention approach that addresses culturally- based perceptions of masculinity, vitality, sexual performance and fertility as HIV/STD risk indicators.

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Female Condom Use in High Risk Women as Predictor of Microbicide Readiness
Research Method: Basic Research
Principal Investigators: Margaret R. Weeks, Ph.D.
Grant: National Institute of Mental Health (NIMH) Office of AIDS Research (OAR) Supplement to R01 MH63631
Dates of Study: 2002-2003
This one year supplement to ICR's "Microbicide Acceptability to Prevent HIV in High-Risk Women" project examines factors that impact the acceptability and adoption of the female condom among women at high risk for HIV in Hartford, CT. There are several important factors in the adoption and use of female condoms that parallel those of vaginal microbicides. This supplement will contribute to the literature on factors that facilitate or impede the adoption, diffusion and acceptability of female-controlled HIV/STI prevention approaches among high-risk women.
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Urban Lifestyles: Club Drugs, Resource Inequities and Health Risks in Urban Youth
Research Method: Basic Research
Principal Investigators: Jean J. Schensul, Ph.D. (PI), Raul Pino, M.D. (Co-PI) Gary Burkholder, Ph.D. (Co-Investigator), Margaret R. Weeks, Ph.D. (Co-Investigator)
Grant: National Institute on Drug Abuse (RFA DA-010101)
Dates of Study: 2001-2006
The purpose of this five-year study is to identify the contextual, socio-cultural, economic, psychological and health-related predictors and consequences of incorporating club and prescription drugs into urban youth drug repertoires, and the ways in which these factors interact over time. The study also examines how media, drug markets, marketing procedures and other economic factors influence the introduction and distribution of new drugs in urban communities, and how youth culture is used to promote norms favoring new drug use.
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HIV Prevention in High-Risk Drug Use Sites: Project RAP
Research Method: Intervention Research
Principal Investigators: Margaret R. Weeks, Ph.D. (PI),
Jean J. Schensul, Ph.D. (Co-PI)
Grant: National Institute on Drug Abuse (1-R01-DA13356)
Partners: Hispanic Health Council
Dates of Study: 2001-2005
The Risk Avoidance Partnership (RAP) project is a cutting-edge, four-year study measuring HIV prevention adoption by individual drug users in Hartford, CT through the conduct, documentation and evaluation of an intervention model that involves active drug users as public health advocates in the diffusion of risk reduction messages and products through peer networks and drug-use settings.
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Microbicide Acceptability to Prevent HIV in High-Risk Women
Research Method: Basic Research
Principal Investigators: Margaret R. Weeks, Ph.D. (PI),
Jean J. Schensul, Ph.D. (Co-PI)
Grant: National Institute of Mental Health R01 MH63631
Dates of Study: 2001-2003
Many women around the world have difficulties negotiating protection from sexually transmitted infections with their partners because they do not have control over means of protection, and often are in relationships where such negotiation would threaten their physical and emotional health. Microbicides offer women the opportunity to protect themselves from HIV and other STDs without requiring consent from their partners. This three-year, U.S.-based study explores the personal, socio-cultural and contextual factors that affect how women involved in high-risk activities (e.g., intravenous drug users, commercial sex workers) will accept and use microbicidal products as a method for HIV and STD prevention.
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A Qualitative and Quantitative Analysis of Perceived Risk for HIV
Research Method: Basic Research
Principal Investigators: Gary J. Burkholder, Ph.D. (PI), Jean J. Schensul, Ph.D. (Co-PI)
Grant: The Center for Interdisciplinary Research in AIDS (CIRA), Yale University
Partners: Center for Interdisciplinary Research in AIDS (CIRA) - Yale University and Institute for Community Research
Dates of Study: 2001-2002
Recent research indicates a rise in HIV infection rates among young men who have sex with men (MSM), with a disproportionate number of infections occurring among MSM of color. This developmental study investigates the underlying dimensions and meanings of perceived HIV risk/susceptibility among young, urban MSM of diverse ethnic backgrounds. Qualitative research is used to assess meanings underlying traditional measures of perceived risk. Results from qualitative analysis will be used to develop a psychometrically sound scale of Perceived Risk for AIDS. This project will provide the groundwork for a larger longitudinal study on the topic.
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Project PACE: Preventing AIDS through Collaborative Efforts
Research Method: Intervention Research
Principal Investigators: Serafin Mendez, Ph.D., LCS (PI), Merrill Singer, Ph.D., HHC (Co-PI), Margaret R. Weeks, Ph.D. ICR (Co-PI)
Grant: U.S. Centers for Disease Control and Prevention U65/CCU118630, primary grantee - Latinos Contra SIDA
Partners: Latinos/as Contra SIDA (LCS), Hispanic Health Council (HHC), Institute for Community Research (ICR)
Dates of Study: 2000-2004
Project PACE is a collaboration between Latinos/as Contra SIDA, the Hispanic Health Council and the Institute for Community Research, with LCS as the primary grantee. The project aims to lower drug-related and sex-related HIV risk among inner-city Latino and African American youth, women and illicit drug users in Hartford, CT. The project uses group level prevention education and support, peer educators, individual prevention case management and street outreach to achieve project goals.
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Effects of Partner Violence Victimization in Drug Using Women (SAVA II)
Research Method: Basic Research
Principal Investigators: Merrill Singer, Ph.D. (PI), Margaret R. Weeks, Ph.D. (Co-PI)
Grant: National Institute on Drug Abuse 1 R01 DA13140 - Lead grantee: Hispanic Health Council
Partners: Hispanic Health Council, Institute for Community Research
Dates of Study: 2000-2003
This three-year project, led by the Hispanic Health Council, examines the relationship between drug use, partner violence victimization, and HIV risk among inner city women. The study investigates how partner violence impacts frequency of drug use, readiness for drug treatment, drug-related sexual risk for HIV and other STDs, and actions to leave abusive relationships.
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Supplement to Pathways to High-Risk Drug Abuse Among Urban Youth: Club Drugs
Research Method: Basic Research
Principal Investigators: Jean J. Schensul, Ph.D. (PI)
Grant: National Institute on Drug Abuse OAR Supplement (DA-11421-02S1)
Dates of Study: 2000-2002
This supplement grant to the study, "Pathways to High-Risk Drug Abuse Among Urban Youth" seeks to understand and document the social and cultural contexts of "club" or "designer" drug use, and sex risks associated with the influx of these new drugs among urban youth in Hartford, CT.
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Minority Supplement to Pathways to High-Risk Drug Abuse Among Urban Youth
Research Method: Basic Research
Principal Investigators: Jose Garcia, B.A. (PI), Jean J. Schensul, Ph.D. (Co-PI)
Grant: Minority Supplement from NIDA Office of Special Populations R01-DS11421
Dates of Study: 2000-2001
This one-year supplement to the study, "Pathways to High-Risk Drug Abuse Among Urban Youth" was designed to study the interaction between the informal and formal economy, and drug selling in Hartford, CT. It examines the ways that youth are drawn into the world of drug dealing, how that world is organized, its role in the lives of youth and their families, and the potential impact of drug selling on the transition from "soft" to "hard" drug use among youth and young adults.
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Building Preventative Group Norms in Urban Middle Schools
Research Method: Intervention Research
Principal Investigators: Jean J. Schensul, Ph.D. (PI), Bonnie K. Nastasi, Ph.D. (Co-PI)
Grant: National Institute on Drug Abuse (#DA12015)
Partners: Yale University School of Medicine, New Haven Public Schools, University of Massachusetts-Amherst
Dates of Study: 1999-2004
This intervention study is developing, conducting and evaluating a new approach to drug and sex-risk prevention in urban middle schools. Working with students and teachers in New Haven, CT, the project compares the standard social development curriculum to one based upon collaborative learning, problem-solving and group consensus.
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AIDS Risk in Older Urban Adult Senior Housing Residents
Research Method: Basic Research
Principal Investigators: Jean J. Schensul, Ph.D. (PI), Kim Radda, M.A., R.N. (Co-PI), Judith Levy, Ph.D., UIC (Site PI), Carmen Reyes, M.P.A., NCAAA (Co-PI)
Grant: National Institute on Aging AG16564
Partners: Institute for Community Research, University of Illinois School of Public Health, North Central Area Agency on Aging, Hartford Housing Authority
Dates of Study: 1999-2003
The goal of this four-year, two-city study is to explore the drug and sexual risks that contribute to the spread of HIV among minority, lower income adults living in senior housing and shelters in Hartford, CT and Chicago, IL. The study considers whether older adult buildings in neighborhoods where injection drug use is common, can be central locations for high-risk activities and associated HIV transmission. Research results will be used as a foundation for individual and group-based intervention strategies appropriate for this population.
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CONNECT 2000: Community-Based Substance Abuse and HIV/AIDS Outreach Program
Research Method: Intervention Research
Project Director: Merrill Singer, Ph.D. (HHC)
Grant: Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration 1 H79 TI12088
Partners: Hispanic Health Council, AIDS Project Hartford, Institute for Community Research, Latinos/as Contra SIDA, Urban League of Greater Hartford
Dates of Study: 1999-2002
This three-year project aims to bridge HIV/AIDS prevention education with substance abuse treatment and health services provision. The project - a collaboration between five agencies in Hartford, CT - is working with high risk, drug-using populations of men and women in the city.
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Comprehensive Elementary School AIDS Education
Research Method: Intervention Research
Principal Investigators: David J. Schonfeld, M.D., Yale University (PI), Jean J. Schensul, Ph.D. (Co-PI), Mary Schwab-Stone, M.D., Yale University (Co-PI)
Grant: Maternal and Child Health Bureau; The William T. Grant Foundation
Partners: Yale University School of Medicine, Yale University Child Study Center
Dates of Study: 1998-2003
The Comprehensive Elementary School AIDS Education project is testing the effectiveness of a comprehensive AIDS education curriculum in public elementary and middle schools in New Haven, CT. Based upon theories of social cognition and influence, the curriculum includes problem-solving and communication skills development, and peer-education. The project is centered at the Yale University School of Medicine; ICR staff are coordinating the process evaluation.
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Community Outreach Prevention Effort COPE III - Longitudinal Study of AIDS Risk Among Injection Drug Users
Research Method: Basic Research
Principal Investigators: Merrill Singer, Ph.D., HHC (PI),
Margaret R. Weeks, Ph.D. (Co-PI)
Grant: National Institute on Drug Abuse (R01 DA11359)
Partners: Hispanic Health Council
Dates of Study: 1998-2001
This three-year study focused on the individual and social context factors that impact AIDS prevention over time among out-of-treatment drug users and crack cocaine users. The project contacted and tracked former participants of Project COPE II for HIV risk reduction and behavior changes, assessing how individual, network and community factors affect HIV risk over the long-term.
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Pathways to High-Risk Drug Abuse Among Urban Youth
Research Method: Basic Research
Principal Investigators: Jean J. Schensul, Ph.D. (PI), Margaret R. Weeks, Ph.D. (Co-PI), Merrill Singer, Ph.D., HHC (Co-PI)
Grant: National Institute on Drug Abuse (R01-DS11421)
Partners: Hispanic Health Council, University of Massachusetts-Amherst,
Yale University
Dates of Study: 1997-2002
This four-year study aims to identify the critical factors responsible for the transition from "soft" or "gateway" drug use (monthly use of alcohol/marijuana/tobacco) to "hard" drug use (weekly heroin and/or cocaine), including injection drug use, among multiethnic inner city young adults between the ages of 16 and 24 in Hartford, CT. The study tests the hypothesis that social networks are more influential than personal vulnerability (social, familial and personal risk and protective factors) in promoting hard drug use and the transition to injecting. A key component explores the ethics of doing research with drug-using adolescents.
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Study of High-Risk Drug Use Settings for HIV Prevention
Research Method: Basic Research
Principal Investigators: Margaret R. Weeks, Ph.D. (PI), Jean J. Schensul, Ph.D. (Co-PI), Merrill Singer, Ph.D., HHC (Co-PI)
Grant: National Institute on Mental Health and the National Institute on Drug Abuse (#U01 DA07284, Project #3). Grantee - Yale University Center for Interdisciplinary Research on AIDS
Partners: Hispanic Health Council, Yale University Center for Interdisciplinary Research on AIDS
Dates of Study: 1997-2001
This three-year study, completed in 2001, identified and explored the characteristics of "high-risk sites" - locations in which individuals gather to inject and/or smoke illicit drugs and exchange sex for money or drugs. Descriptions of the personal networks of the people who frequent these high-risk sites, and measured receptivity of site "gatekeepers" to HIV prevention was used to determine the potential for a peer-led, site-based prevention intervention. This project is a joint ICR/Hispanic Health Council study, and was funded as one of four core projects composing the original Yale University Center for Interdisciplinary Research on AIDS (CIRA).
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Intertwined Epidemics Among Puerto Rican Drug Users: Substance Abuse, Violence, and AIDS (SAVA)
Research Method: Basic Research
Principal Investigators: Merrill Singer, Ph.D., HHC (PI),
Margaret R. Weeks, Ph.D. (Co-PI)
Grant: National Institute on Drug Abuse (R01 DA10438); Lead grantee - Hispanic Health Council
Partners: Hispanic Health Council, Institute for Community Research
Dates of Study: 1997-2000
This three-year study explored at the intersection between substance abuse, violence and HIV risk in Hartford's Puerto Rican communities. The project, a collaboration between the Hispanic Health Council and the Institute for Community Research, examines factors that influence or impact the relationship among these three epidemics at the individual, network and neighborhood levels.
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The Community Outreach Prevention Effort II: Project COPE II
Research Method: Basic Research/Intervention Research
Principal Investigators: Merrill Singer, Ph.D., HHC (PI)
Margaret R. Weeks, Ph.D. (Co-PI)
Grant: National Institute on Drug Abuse (#U01 DA07284)
Partners: Hispanic Health Council (grantee), The Hartford Dispensary, the Urban League of Greater Hartford, Latinos/as Contra SIDA, The Hartford Health Department
Dates of Study: 1992-1997
Project COPE II was a five-year HIV prevention study that built upon lessons learned in Project COPE I. The study targeted active, out-of-treatment injection drug and crack cocaine users in Hartford, CT, monitoring their drug use, HIV risks, and prevalence of HIV infection. The study also tested the comparative efficacy of culturally-targeted AIDS education against a standard intervention program. As part of the national, multi-site Cooperative Agreement for AIDS Community-based Outreach/Intervention Program, the project was a conducted by the six-organization Community Alliance for AIDS Prevention (CAAP), with the Hispanic Health Council as the lead grantee.
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Project COPE: Preventing AIDS Among Injection Drug Users and their Sex Partners
Research Method: Basic Research and Intervention Research
Principal Investigators: Jean J. Schensul, Ph.D. (PI), Merrill Singer, Ph.D. (PI)
Grant: National Institute on Drug Abuse (#R18-DA05750)
Partners: Hispanic Health Council (HHC), The Urban League of Greater Hartford, Latinos/as Contra SIDA, The Hartford Dispensary, Hartford Health Department
Dates of Study: 1988-1992
This four-year study examined drug use patterns and AIDS risk behaviors among injection drug users and their sex partners in Hartford, CT, and evaluated the effectiveness of culturally-based prevention interventions against a standard intervention program. The study was part of the National AIDS Demonstration Research project, and one of 29 similar studies across the nation. It brought together five Hartford organizations into a community-based consortium of researchers and services providers that collaborated in future studies.
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