We propose to develop a theoretically and ethnographically informed model of """"""""HIV risk environment"""""""" for public health intervention by identifying the key structural forces, institutional processes, and socio-cultural constraints that shape HIV behaviors among inner-city street-based drug users. We will examine the social processes that drive the logics for HIV transmission behaviors among street-based injection drug users (IDUs) in two cities, Philadelphia and San Francisco, that span a strategic range of the demographic, economic, political, and cultural factors affecting inner-city poverty in the United States. Building on long-term, continuous participant-observation ethnographic fieldwork in the shooting encampments of ethnically and generationally bounded social networks of heroin injectors and crack smokers in San Francisco as well as pilot research in Philadelphia at open-air drug markets and shooting galleries, we will document patterns of: 1) law enforcement and criminal justice;2) poverty and income generating opportunities (including legal and illegal labor markets and public subsidies);3) illegal drug markets and polydrug availability;4) racialized ethnic boundaries and conflicts;5) gender/sexuality boundaries that delimit social networks;6) oppositional sub-cultural identities that trap IDUs into counterproductive relationships with the services that are meant to help or contain them;7) violence and insecurity;8) access to clinical care, public health prevention messages, and social services;9) access to ecological and basic survival needs infrastructures including transportation systems, food, and shelter from inclement weather. An experienced ethnographic team in both cities will collect data on individual-level HIV risk behaviors at fieldsites that we have successfully maintained on the parent grant for more than 12 years in San Francisco and recently established in Philadelphia (core N of each network=15-20 at any given time, peripheral N=10-15 in each fieldsite;2 sites in Philadephia and 2 in San Francisco). The project will administer a set of procedures for cross-methodological collaboration with epidemiologists who are the Principal Investigators on long-term, large quantitative data sets documenting street-based drug users in both cities. This will enable us to examine the representativity of our ethnographic data on individual street-based drug users and to explore the generalizability of our analysis of the larger social structural processes that promote or constrain risky injection and sexual practices. It will also bring one of the largest and oldest NIDA-funded data sets on IDUs in San Francisco, an exceptionally high-tech, wealthy, culturally diverse, and liberal city into an illustrative contrast and dialogue with another large NIDA-supported quantitative data set of street-based drug users in the city of Philadelphia, one of the nation's poorest deindustrialized metropolises, with a declining population of largely native-born white, Latino (primarily Puerto Rican) and African American ethnic groups.

Public Health Relevance

Untangling the complex web of factors that render inner city poverty environments exceptionally risky for HIV infection and addiction will help public health outreach workers and clinicians develop more innovative structural and targeted interventions to reach larger numbers of low income high-risk populations with more effective and convincing messages. Upstream interventions that alter neighborhood-level risk environments can cost-effectively encourage drug users to change their behaviors for pragmatic reasons without necessarily requiring a conscious or willful choice. Our findings will also identify strategic institutions and programs that often operate at cross purposes or fail to coordinate with public health HIV risk reduction priorities (including law enforcement, criminal justice, employment training, public housing, food kitchens, shelters, schools, and churches) but which represent productive sites for multi-service HIV prevention interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA010164-16
Application #
8465205
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Lambert, Elizabeth
Project Start
1996-03-01
Project End
2015-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
16
Fiscal Year
2013
Total Cost
$376,221
Indirect Cost
$130,619
Name
University of Pennsylvania
Department
Social Sciences
Type
Schools of Arts and Sciences
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Bourgois, Philippe (2018) Decolonising drug studies in an era of predatory accumulation. Third World Q 39:385-398
Branas, Charles C; South, Eugenia; Kondo, Michelle C et al. (2018) Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear. Proc Natl Acad Sci U S A 115:2946-2951
Bluthenthal, Ricky N; Chu, Daniel; Wenger, Lynn D et al. (2018) Differences in time to injection onset by drug in California: Implications for the emerging heroin epidemic. Drug Alcohol Depend 185:253-259
Bourgois, Philippe; Holmes, Seth M; Sue, Kim et al. (2017) Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care. Acad Med 92:299-307
Bluthenthal, Ricky N; Wenger, Lynn; Chu, Daniel et al. (2017) Drug use generations and patterns of injection drug use: Birth cohort differences among people who inject drugs in Los Angeles and San Francisco, California. Drug Alcohol Depend 175:210-218
Culyba, Alison J; Jacoby, Sara F; Richmond, Therese S et al. (2016) Modifiable Neighborhood Features Associated With Adolescent Homicide. JAMA Pediatr 170:473-80
Bourgois, Philippe; Hart, Laurie Kain (2016) [Pax Narcotica : The Open-Air Drug Markets of Philadelphia's Puerto Rican Inner City]. Homme 3:31-62
Mars, Sarah G; Bourgois, Philippe; Karandinos, George et al. (2016) The Textures of Heroin: User Perspectives on ""Black Tar"" and Powder Heroin in Two U.S. Cities. J Psychoactive Drugs 48:270-8
Wenger, Lynn D; Lopez, Andrea M; Kral, Alex H et al. (2016) Moral ambivalence and the decision to initiate others into injection drug use: A qualitative study in two California cities. Int J Drug Policy 37:42-51
Branas, Charles C; Kondo, Michelle C; Murphy, Sean M et al. (2016) Urban Blight Remediation as a Cost-Beneficial Solution to Firearm Violence. Am J Public Health 106:2158-2164

Showing the most recent 10 out of 64 publications