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