Archival Content: 1999-2005
HIV Prevention Among Drug Users:
Estimating the Extent of Local Drug Use
Thus far, PART 1 has given an overview of various types of drugs, the range of drug-using behaviors, the general patterns and trends of drug use, and an understanding of drug dependence and drug treatment. This provides important background for developing HIV prevention programs for drug users at the local level. In order to develop effective community programs, however, planners and program managers need to have an accurate understanding of local drug-using behaviors, drug-use environments, affected populations, and local patterns and trends.
This information may be difficult to obtain. Traditional survey methods and other techniques that may be used to estimate local drug use have distinct limitations. For example, some people may not admit to using drugs or will understate their drug use because drug use is illegal and socially unacceptable. In addition, chronic drug users often are not reached by traditional community surveys. Difficulties in accurately estimating the number of people who inject specific drugs, such as heroin, cocaine, and amphetamines, are further compounded because IDUs may use several drugs in combination or may vary their drug-using behaviors over time by switching from one drug or method of use to another (e.g., injecting to snorting).
Because of the difficulties in obtaining exact information on the extent and patterns of drug use in a given community, it is important to gather information on drug use from a variety of sources and combine them to obtain general estimates of the extent and patterns of drug use in the community. Table 1.2 summarizes potential local sources of information on drug use trends and patterns. In combination, they can increase prevention planners' and program managers' understanding of the drug use situation in their community, which in turn, will enhance their ability to support more effective HIV prevention programs for drug users.
Each of these sources will present its own opportunities and challenges. When approaching government agencies, such as drug treatment and prevention agencies, boards of education, or the criminal justice system, for example, it is best initially to contact staff who oversee information and data management for the agency. These agencies may have other useful data in addition to data on drug-use trends and patterns, and the information/data management staff will likely be in a good position to bring them to the attention of prevention planners. The criminal justice system may have data on the number of drug-related arrests, what drugs were confiscated in arrests, and high-use neighborhoods and populations. State boards of education contribute information to the CDC-supported Youth Risk Behavior Survey, which collects some drug-use data on a sample of 9-12th grade students.
Prevention planners also can seek relevant data from the community drug treatment programs or public health clinics, with the understanding that their data collection systems are often limited. These data collection systems vary considerably as to their reporting requirements and staff capacity to summarize data in an aggregate way. A priority for many prevention programs and clinics is to gather data on service delivery to report to their funders rather than to gather data on patterns and trends of drug use among their targeted population. When relevant data are not available from programs serving drug users, planners can conduct structured interviews with a representative sample of professional providers.
Research institutions, often university or hospital-based, are another source of relevant data. Research projects related to drug use often are located in departments such as public health, psychiatry, psychology, sociology, anthropology, or social work. If the institution has a research department, staff there often can respond initially or through direct data inquiries to other departments.
Prevention planners also should use public libraries in seeking relevant local data and information. Literature searches on drug use can often identify reports or surveys that have been conducted. In addition, a search of newspaper files can identify articles on drug use and drug use environments.
Another valuable source of information on drug use is the Community Epidemiology Work Group (CEWG), a National Institute on Drug Abuse (NIDA)-supported network of researchers from 20 major metropolitan areas of the U.S., Canada, and Mexico. The CEWG provides current descriptive and analytical information regarding the nature and patterns of drug abuse, emerging trends, and characteristics of vulnerable populations.5 Table 1.3 lists the 20 major metropolitan areas surveyed by the CEWG:
Finally, planners should not underestimate the value of gaining information about trends and patterns of drug use from drug users themselves. Key informant interviews and focus groups with active drug users or those in treatment can yield information about current practices, drugs of choice, and their availability. These interviews will also provide planners and managers with a more holistic understanding of the lives of drug users. These interviews should be arranged through staff who work in programs for active and inactive users.
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