Perceived importance of condom use among African Americans using drugs

American Journal of Health Studies, Spring-Summer, 2003 by Joseph Schumacher, Min Qi Wang, Sacia Dear, Sapna Marepally, Foster Cook

HIGH RISK COMMUNITY

In neighborhoods and populations where HIV and STDs are widespread, condom use is particularly important. Studies of local area variation (typically based on census block-groups or census tracts) have found that the HIV/AIDS epidemic has been concentrated in areas with a high proportion of racial/ethnic minorities and the poor (Fife & Mode et al., 1992; Hu et al., 1994; Krieger et al., 2000; Morse et al., 1991; Simon et al., 1995). Approximately half of current HIV incidence in this country occurs among drug injectors (Holmberg, 1996), largely among those in impoverished racial/ethnic minority neighborhoods. Heterosexual AIDS cases have been increasing in the metropolitan cities, and are concentrated in a few neighborhoods that are also the loci for HIV/AIDS among injection drug users (IDU) (Fordyce et al., 1999). Thus, in many ways the problem of preventing heterosexual transmission of HIV requires heavy focus on neighborhoods where drug use and HIV are both prevalent.

RESEARCH CONTEXT AND PURPOSE

Although there have been a few studies regarding non-injection drug use and HIV risks, there is limited data on African American users of drugs. More empirical information is needed in this area. As a result, the Center for Substance Abuse Treatment funded a multi-site street outreach project. This study, funded as one of these sites, examined the relationship between the perceived importance of using condoms and the condom use among African American users of drugs (marijuana and cocaine) in a street outreach study. Despite the existence of scientific evidence that consistent condom use is a key factor in reducing heterosexual transmission of HIV, the cognitive factors that govern condom use, especially in non-injected drug (crack, marijuana) users is not very clear. As such, this study investigated perceived importance of condom use, the type of sex partners, drug use type, and gender of a group of African American users of drugs in a high-risk street outreach study. These factors have been cited in the literature (Davis & Weller, 1999).

METHODOLOGY

SURVEY SITE SELECTION

Data for this study were collected in a cross-sectional community survey conducted for a drug abuse and HIV prevention study in Birmingham, AL. Four zip codes were selected based on seven health and criminal justice indicators of risk for HIV, STDs, and substance abuse. These indicators included Drug Use Forecasting data, Healthy Start data, and STD and HIV prevalence data, which were used to identify comparable high-risk zip codes. The sites for the intercept interviews within each zip code were systematically selected to obtain the greatest number of drug users. Informants, such as neighborhood association leaders, former users of substances, and local police, helped identify drug-trade areas.

SAMPLING PROCEDURES

Interviewers talked to all the potential participants. Only those who indicated that they used illicit drugs (marijuana or crack) during the past 6 months were interviewed. Participants had to be adults, fifteen years or older who were traveling on foot, unarmed, and appeared to be indigenous to the area.