This R03 application proposes an exploratory study addressing factors related to the drug use and HIV nexus, a direction new to HIV research in Nicaragua where the relationship between drug use and HIV is not yet programmatically or politically recognized. The study design includes the use of ethnography and a qualitative approach for this initial, exploratory study of drug user patterns in the country. The study will also provide the opportunity to mentor the research skills of the leading HIV-focused NGO in Nicaragua. The objective of the research is to explore the relationship of drug use to HIV in Nicaragua's capital city, Managua. It will identify and describe the context and specific drug use behaviors that influence HIV risk. The project will be conducted by a team of researchers from the United States and Nicaragua with extensive experience in HIV-drug use research with Hispanic populations and experience with policy development in Nicaragua. The project will consist of 3 phases: (1) Background data collection and training in country on drug use, drug research methodology, and the relationships between drug use and HIV; (2) Instrument development, pre-testing and data collection (including focus groups with high risk behavior and gatekeeper communities, key informant interviews, and semi-structured, open-ended interviews with users of illicit drugs [cocaine, crack, heroin and pharmaceuticals]); and (3) Data analysis and dissemination (including summary reports prepared in English and Spanish), which will incorporate recommendations for future research and prevention efforts. The dearth of behavioral and other data on HIV and substance abuse in Nicaragua, a country with many of the preconditions for a drug use-HIV epidemic, point to the critical need for the proposed research.
