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New Directions in Research: Risk Reduction for HIV/AIDS

The impact of HIV and AIDS in African-American communities has been devastating throughout the United States. According to the Centers for Disease Control and Prevention (CDC), almost 38% of reported AIDS cases occur among African Americans, even though African Americans represent approximately 12% of the total U.S. population. In 2000 alone, more African Americans were reported with AIDS than any other racial or ethnic group. Nearly half of AIDS cases reported during that year were among African Americans, and the rate of their reported AIDS cases was 58.1 per 100,000 population-more than twice the rate for Hispanics and eight times the rate for whites. 

Although research addressing HIV/AIDS involves a broad spectrum of basic science and clinical investigations, there have been few studies that consider culturally specific risk factors and risk reduction mechanisms as unique factors affecting particular groups of people. A $2.2 million study funded by the National Institute of Drug Abuse is evaluating the effectiveness of culturally specific HIV/AIDS risk reduction programs among drug-dependent African American men in order to offer solutions for this growing problem. The study, referred to as JEMADARI, is directed by Professor Larry Gant. Along with Professor Carol Boyd of the School of Nursing, he will examine the effects of coping skills, perceptions of personal control, ethnic identity, life satisfaction, and peer group support on drug and risky sexual behavior.

As Gant notes, "JEMADARI is taken from Kiswhaili and roughly translates into 'Wise Companion.' We developed JEMADARI at the request of women who were involved in another HIV prevention program. They noted that while their involvement in the program (called NJIDEKA-'Survival is Powerful') transformed their life, the men in their lives were often left behind." Gant quotes one of these women as saying "some of us actually like these guys and want them to grow along with us-we don't want to leave them!"

JEMADARI provides structured intervention in relapse prevention, sexual dysfunction, relationship building, and critical self assessment. Gant says that he and his colleagues developed JEMADARI "in response to the frequent relapse to risky drug and sex behaviors from participants in interventions that focus directly on behavior change." Their empirical research, he claims, indicates that "behavior change is more enduring when placed in the content of its use in maintaining good relationships with children, adult partners, and identified neighborhood or community-particularly for African American men and women in this population."

Focusing on drug-dependent African American men is particularly important since HIV/AIDS continues to represent their leading cause of death between the ages of 25 and 34. While African American men represent less than 6% of the total U.S. population, they constitute 32% of all male AIDS cases in the country. According to the CDC, the annual incidence rate in 1998 of AIDS diagnoses in men between the ages of 25 and 44 was five times higher for African American men than for white men. Data from the National Cancer Institute indicates that that ratio of African American men between the ages of 27 and 39 infected with HIV is 1:33, compared to the ratio of 1 in 250 for white men. Approximately 75% of HIV/AIDS cases attributed to drug use are in African American men, and as many as 33% of the nation's 1.2 million injection-drug users (IDU) may be HIV-infected, according to the CDC. 

According to Gant, mainstream residential drug treatment programs can impact HIV/AIDS risk significantly. However, several studies have shown that the effects of culturally specific programs can have greater impact. "Interventions that address the persons' experiences and lifestyles-as well as norms, values, and mores-tend to provide more connections to the intervention. These connections can form a safety net which helps that person maintain their new behavioral changes and helps to minimize 'falling through the cracks into relapse,"' says Gant. 

The CDC have stated that culturally specific challengesincluding continued health disparities and substance abusehave contributed to the spread of HIV/AIDS in African-American communities. They also have noted that prevention and treatment services must be more effectively integrated with communities and community organizations. While some culturally specific programs have been adapted to reduce both sex- and drug-related behavior for drug-dependent African American women and youth, no such programs have been developed for drug-dependent African American men that either were culturally specific or that demonstrated changes in both drug and sex related risk behaviors. Prospective interventions, Gant notes, should " incorporate the perspectives of African American men-including their contextualization of sex- and drugrelated behavior in relationships, social support, self-perception, and employment."

Gant's goal is to identify culturally specific programs that may be effective for drug-dependent African American men. His research design incorporates a model of social cognitive theory that combines contextually based learned skills with exercises increasing personal confidence and use of these skills. The study will incorporate the special needs and perspectives of this population, including the unique dynamics and sex and drug behavior within the context of relationships, social support, self-perception, and employment.

Until this study, few investigations had examined the relative success of culturally specific programs compared to existing mainstream programs. Beginning with a six-month quality assurance phase, the study initially will involve work with the Oasis site of Detroit Rescue Mission Ministries (DRMM). This will be followed by a two-year testof the program using a stratified, randomized cluster design with 600 participants located in five DRMM residential facilities.

Gant anticipates that this study will enhance HIV prevention efforts by: developing a new theoretically and empirically based, culturally specific intervention; introducing proven strategies before launching wide-scale HIV risk-reduction programs targeted at specific cultural populations; and reducing risk for HIV infection in an extremely vulnerable population. If successful, the approach and strategies for creating these interventions can be exported to other populations; at risk for their review and considered use. This study is being conducted within a wider inventory of research in the School considering cultural Research assistants meet with Larry Cant. contexts and involving community partners. Gant's study is an example of a study that combines relevant cultural contexts with theory-driven interventions, establishes reciprocal linkages with specific populations, and creates reciprocal relationships with community agencies. 

By enhancing the readiness of drug-dependent African American men for behavioral change, JEMADARI's goal is to reduce the HIV risk behaviors in this population. "This is a wonderful example of the collaboration across universities (University of Michigan, University of California-San Francisco), the City (of Detroit) Health Departments' HIV/AIDS and Early Intervention Programs, and community-based residential drug treatment programs," notes Gant. "The process of collaboration can be long and challenging, but can ultimately be productive and successful."

Written by Nili Tannenbaum

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