This R21 proposes an innovative study to examine the emerging community response to methamphetamine (meth) use among men who have sex with men (MSM) and associated increases in HIV risk behavior. A drug epidemic can stimulate the spread of HIV directly, through needle use, or indirectly, as in the association between crack use and unsafe sex. There are strong indications that the current wave of meth use among MSM is associated with both unprotected sex and HIV infection. Prior research indicates that community action can significantly slow or even halt HIV and drug epidemics. Community response to an epidemic occurs at three levels: 1) individual attitudes and behavior, 2) norms and communication within social networks, and 3) the actions of community organizations and businesses. This study will use qualitative methods to explore the emerging response to meth use and related HIV risk behavior. We will conduct semi-structured interviews with 60 MSM recruited from diverse venues (MSM interviews) and 40 service providers, community activists and business owners (stakeholder interviews), and conduct participant observation within MSM communities and policy venues. Qualitative methods have been a vital element of research on the dynamics of HIV risk and prevention since the early days of the epidemic and continue to be widely used today. This proposed research will address the following specific aims: 1. Examine community responses to growing meth use and associated increases in HIV risk behavior among MSM in NYC. This overall aim has 3 components: A. Assess attitudes towards unsafe sex and meth use among MSM in NYC, and identify social processes shaping attitudes and (risk and preventive) behaviors, including personal history, social network composition, perceived peer norms, and encounters with health education programs and materials. B. Describe informal responses to meth use and unsafe sex within MSM peer networks, and identify social processes associated with indigenous efforts to influence network norms regarding risk behavior. C. Document the range of interventions by stakeholders in response to meth use, and examine processes of intervention development. 2. Identify similarities and differences between stakeholder and individual or social network responses to meth. 3. Develop an integrated theoretical model of community response to meth use and associated HIV risks. 4. Disseminate findings to health officials and service providers to support development of new prevention strategies. The time frame for the study will enable quick dissemination of data to Community Based Organizations and health officials, while refining theoretical and methodological approaches to support future research. Public Health Relevance Statement This study will interview a diverse group of MSM, service providers, activists, and some business owners in order to get information about multiple levels of MSM community response to meth in NYC, from the attitudes of individuals and their friends to health promotion campaigns and drug treatment services to policies about drug use in dance clubs. This study will improve knowledge about how communities respond to increases in drug use and drug-related HIV risk behavior. A better understanding of community action in relation to drug use and HIV is vital to controlling the spread of HIV and managing waves of drug use in the future. ? ? ?
| Braine, Naomi; van Sluytman, Laurens; Acker, Caroline et al. (2011) Sexual contexts and the process of risk reduction. Cult Health Sex 13:797-814 |
| Braine, Naomi; Acker, Caroline Jean; van Sluytman, Laurens et al. (2011) Drug use, community action, and public health: gay men and crystal meth in NYC. Subst Use Misuse 46:368-80 |
