This A-START application proposes formative research aimed at understanding the role of illicit drugs in the transmission dynamics of sexually transmitted infections (STIs) and HIV among 18-30 year old African Americans (AA) living in high-risk neighborhoods. The study has two specific aims: 1) collect pilot data on drug behaviors, drug-related incarceration history, and sexual behaviors of young AA adults living in HIV/STI high prevalence community areas of Chicago, and 2) determine the feasibility of using respondent-driven sampling (RDS) to recruit a large sexual network of young AA adults living in a bounded high-risk community area. Pilot data (Aim 1) will be collected through 8 focus groups of 8 members each, stratified by age and gender (two groups of 18-24 year olds and two groups of 25-30 year olds for each gender). Focus group participants will be recruited via flyers and street outreach in the target high-risk community areas. Focus groups will be aimed at understanding young AA adults'drug and sex behaviors and perceptions, including types and patterns of drug use, drug use as a sex enhancer, the context of drug and sex behaviors, perceived impact of incarceration on STIs/HIV in their communities, perceptions of risk, and use of STI/HIV prevention/treatment resources. In addition to the focus groups, 5 representatives from local HIV service organizations and STI clinics serving the targeted high-risk community areas will be interviewed to obtain providers'perspectives on STI/HIV risk among young AA adults.
Aim 2 -determining the feasibility of using RDS to recruit a sexual network of young AA adults-will occur in 2 stages. In Stage 1, initial 'seed'recruiters drawn from the focus group participants will begin an RDS chain of drug users from which representative members will be drawn to begin Stage 2: recruitment of a small AA young adult sex network from an HIV/STI high prevalence community area on Chicago's South Side. These eligible members from Stage 1 will serve as seeds in an RDS chain. The seeds will be given incentives to recruit their sex partners, who will then be asked to recruit their sex partners and so on until an N of 200 is reached and potential problems using RDS to recruit sex partners in the target group are identified and overcome. All participants from both Aims will be asked to complete a brief risk behavior survey via ACASI and a brief sexual network questionnaire describing their sex partners. All participants will be offered HIV testing and referrals for STI testing/treatment. Descriptive analyses will be performed for survey and test result data. Focus group and qualitative interview sessions will be transcribed and analyzed to identify both the range and major themes regarding risky drug and sexual behavioral patterns and perceptions of risk. All data will be used to inform the development of a subsequent proposal that will use a social network perspective to better understand partner concurrency and the role of illicit drugs in the transmission dynamics of STIs and HIV among young adult African Americans living in HIV/STI high-prevalence urban neighborhoods.
This study aims to lay the groundwork for understanding the role of substance use in the sexual transmission of HIV and other sexually transmitted infections among a community sample of African American young adults. Understanding the intersection of substance use with dynamics of sexual transmission of disease is important in reducing HIV infection among vulnerable populations.