Racial/Ethnic Disparities in the HIV and Substance Abuse Epidemics: Communities Responding to the Need

Hortensia Amaro, Anita Raj,

Rodolfo Vega, Thomas Mangione,

Lucille Norville Perez

The CSAP Minority AIDS Initiative (MAI)

• In 1998, the Congressional Black Caucus and the Hispanic Latino Caucus advocated and created the Minority AIDS Initiative (MAI) to address HIV in communities of color.

• As part of the MAI, the Center for Substance Abuse Prevention funded the Substance Abuse Prevention/HIV Care Targeted Capacity Expansion Minority HIV Initiative.

Goals of Initiative

 

• To increase capacity in minority communities

• To deliver prevention services to African-American & Hispanic Women

• To deliver prevention services to minority youth

Funding of the CSAP Minority AIDS Initiative

• 47 agencies across the United States were funded to develop capacity to address the drug and HIV epidemics within racial/ethnic minority communities

• 1 project coordinating center was funded to provide technical support to these agencies and oversee a cross-site evaluation of this initiative

Description of Programs

Programs are diverse in:

• Populations Served

• Structure of Interventions• Intervention Approach

Primary Research Questions

• Does the program increase HIV-related risk perceptions and decrease or prevent HIV-related risk behaviors?

• Does the program increase substance abuse-related risk perceptions and decrease or prevent substance use-related behaviors?

Methods

• Quasi-experimental design: repeated measures with comparison group

• Data collected via a Cross-site Survey Instrument at:- baseline- 3 months post-baseline- 6 months post baseline

• 3 Versions of the Survey were developed for: (1) adults, (2) adolescents and (c) children

Methods

• Program and comparison participants will be compared on - major outcome variables mediating

variables• Moderating effects of demographic

(e.g., race/ethnicity, age) and contextual variables (e.g., relationship violence, neighborhood risk) will be assessed

Measures

• Outcome Variables*- Sexual and IDU Risk Behaviors- Substance Use/Abuse Behaviors

• Mediating Variables- Sexual Risk Attitudes and Risk

Perceptions- Substance Abuse Attitudes and Risk

Perceptions* Not included in Children’s Survey

Measures• Contextual Variables

- Neighborhood Risk- Experiences of Racism- Power Disparities and Abuse in Relationships*

• Demographics- Gender -Education*- Age- Race/Ethnicity

• Included in Adult Survey Only

• 2695 Baseline Surveys Processed• 385 Children Surveys

- 1,068 Adolescent Surveys- 1,242 Adult Surveys

• Data for all time points is still being collected

• Data presented here are preliminary

Preliminary Findings

Participant Profile

Adult Adolescents

Mean Age 38.9 15.8

Gender % Female 81.1 48.8% Male 11.9 51.5

Race% Black 57.7 67.3% Hispanic 32.0 25.5% Other 4.6 1.9

Language Spoken by Adolescent and Women Respondents

Women Adolescents

English mostly or only 72.3% 89.0%English & other equally 18.2% 17.9%Other mostly or only 9.5% 2.1%

Country of Origin

WomenAdolescent

Country/Origin

U.S.* 73.4% 88.4%

Other 26.6% 11.6%* Continental US

*Adolescents: Sexual Risk

Ever had sex 50.1%Mean age at first sex 13.2 years Used condoms at first sex 69.1%

Had sex in past 3 months 65.3%*

* Question asked only of those who were sexually active

*Sexually Active Adolescents in Past 3 Months

Used Condom at Last Sex 48.9%

Mean Number of partners 2.7

Had unprotected sex for $ 6.1%

Had unprotected sex within

HIV+ partner 1.3%

Had unprotected sex with IDU 3.3%

*Women: Sexual Risk

Ever had sex 95.7%Mean age at first sex 16.1 yearsUsed condoms at first sex 29.6%

Had sex in past 3 months 57.0%*

* Question asked only of those who are sexually active

*Sexually Active Women in Past 3 Months

Used condom at last sex 60.9%

Mean number of partners 1.5

Had unprotected sex for $ 13.8%

Had unprotected sex within HIV+ partner 2.7%

Had unprotected sex with IDU 3.3%

Adolescents: Substance Use

Ever smoked a cigarette 40.6%

Ever had a drink 49.5%- In the past 30 days 30.4%

Ever used marijuana 34.8%- In past 30 days 30.4%

Ever used illicit drugs 19.9%- Mean age at first use 13.1 years

Women: Substance Use

Ever had a drink 69.5%- In the past 30 days 36.3%

Ever used marijuana 40.7%- In the past 30 days 13.9%

Ever used illicit drugs 36.4%- In the past 30 days 27.6%- Mean age at first use 19.3 years

Adolescents: Experiences of Racism

Due to their race, in the past 6 months:Called insulting names 52.3%Monitored by security while shopping

54.6%Found it hard to keep/find a job 56.1%Stopped by police 18.8%Had their house vandalized 14.9%Were physically attacked 18.9%

Women: Experiences of Racism

Due to their race, in the past 6 months:Called insulting names 43.8%Monitored by security while shopping 47.3%Found it hard to keep/find a job 49.3%Found it hard to get a loan 23.1%Refused housing 17.1%Stopped by police 19.9%House vandalized 9.1%

Women: Experience of Violence

0

10

20

30

40

50

Emotional Physical Sexual

Main Partner* Non-Main Partner* Others (Ever)

%

*Past 3 months

Women: General Relationship Power

0 10 20 30 40

Has more say

Dictatesclothes

Forbidsfriends

Does what hewants

Percent

Partner:

Women: Relationship Power in Condom Use

0 5 10 15 20 25

Ignore them

Leave them

Get angry

Get Violent

Percent

Believe partner will:

Conclusions

• The CSAP Minority AIDS Initiative is reaching the community based agencies and populations for which it was intended

• Implementation process had demonstrated growth in capacity to implement HIV interventions and evaluation

Contextual Factors: Racism

• Experience of racism was reported by a significant proportion of participants.

• Reports of victimization among women were high. Compared to Hispanic women, African American/Black women were especially at risk for experiencing abuse from other than current partners.

Contextual Factors: Violence

• For approximately 1 in 4 or 1 in 5 women participants, lack of power in their primary relationship affected their ability to make free decisions and choices

• 1 or 2 in 10 women expect a serious negative response from their partner if they request condom use

Implications

• Informing the field about adaptations of evidence based HIV prevention approaches

• Advancing the knowledge base on the role of contextual factors in HIV risk among communities of color

• Lessons learned about capacity building and implementation within CBO’s