The Risk Avoidance Partnership: Training Active Drug Users As Peer Health Advocates

Summary

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Efforts have expanded to create AIDS prevention programs for drug users that consider the social context and interpersonal relationships within which risky practices take place. The Risk Avoidance Partnership (RAP) project is designed to train active drug users as peer/public health advocates (PHAs) to bring a structured, peer-led intervention into the sites where they and their drug-using social networks use illicit drugs. The RAP peer health advocacy training curriculum and peer-led intervention promote harm reduction among drug users and support drug-user organization to reduce infectious disease and other harm in the context of injection drug use, crack cocaine use, and sexual activity. Initial findings suggest that RAP PHAs perceive a significant positive role change in themselves while conducting health advocacy work and willingly and successfully carry the peer-led intervention into locations of high-risk drug activity to deliver it to their peers even in the absence of project staff support.

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The Risk Avoidance Partnership: Training Active Drug Users As Peer Health Advocates

INTRODUCTION

Over the past 20 years, AIDS prevention efforts with street drug users have demonstrated the potential for significant health-related and socio-political change leading to personal and environmental reduction in HIV and other drug-use related risks. This work has also illustrated the tenacity of barriers to those changes and the limitations to many of the currently tested approaches to prevention among people at highest risk. Researchers increasingly recognize the need for prevention programs with drug users that address the social context and interpersonal relationships within which risky practices take place (Needle, Coyle, Normand, Lambert, & Cesari, 1998; Singer & Weeks, 1996; Weeks et al., 2001). Some efforts to address this need have involved targeting drug users' social networks with prevention efforts (Broadhead et al., 1998; Latkin, 1998a; Latkin, Sherman, & Knowlton, 2003; Neaigus, 1998; Trautmann, 1995; Trotter, Bowen, & Potter, 1995; Valente, Foreman, Junge, & Vlahov, 1998). Others have built upon the potential of drug users to organize themselves politically and socially to address health and other community issues (Crofts & Herkt, 1995; Friedman, DesJarlais, & Ward, 1994; Friedman et al., 2004; Moore & Wenger, 1995; Roe, 2001). These efforts appear to extend the reach of prevention effects and begin to address factors that reduce the long-term effectiveness of individually-oriented approaches.

The Risk Avoidance Partnership study, or Project RAP, is one such project that builds on social relationships among those at risk to enhance and expand HIV prevention efforts. The project combines a social network diffusion model using peer leaders to disseminate intervention with a social organizing component to build a base for ongoing coordinated efforts of those peer leaders. RAP is designed to train active drug users as "peer/public health advocates" (PHAs) to bring a structured, peer-led intervention into the sites where they and their drug-using peers use illicit drugs. The RAP peer health advocacy training curriculum, peer-led intervention, and community advocacy groups advocate harm reduction among drug users (Rhodes & Hartnoll, 1996; Single, 1995; van Ameijden et al., 1992) and support ongoing drug-user organization for health promotion to reduce diseases and other harm in the context of injection drug use, crack cocaine use, and sexual activity. We report here on the theoretical framework and design of the PHA training program. We also describe key components of the RAP peer-led intervention the PHAs were trained to provide and present process findings and immediate outcomes of the RAP training program on study participants. Among these findings are a more specific understanding of what trained PHAs provided to their peers and how they provided it, as well as the role of "empowerment" in motivating PHAs to conduct intervention and to change their own risk behaviors.

PEER AND NETWORK INTERVENTION MODELS: THEORETICAL FRAMEWORK

Social network interventions have been desi...

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