Racial/Ethnic Disparities in the HIV and Substance Abuse Epidemics: Communities Responding to the Need Hortensia Amaro, Anita Raj, Rodolfo Vega, Thomas Mangione, Lucille Norville Perez

The CSAP Minority AIDS Initiative (MAI) In 1998, the Congressional Black Caucus and the Hispanic Latino Caucus advocated and created the Minority AIDS Initiative (MAI) to address HIV in communities of color. As part of the MAI, the Center for Substance Abuse Prevention funded the Substance Abuse Prevention/HIV Care Targeted Capacity Expansion Minority HIV Initiative.

Goals of Initiative To increase capacity in minority communities To deliver prevention services to African-American & Hispanic Women To deliver prevention services to minority youth

Funding of the CSAP Minority AIDS Initiative 47 agencies across the United States were funded to develop capacity to address the drug and HIV epidemics within racial/ethnic minority communities 1 project coordinating center was funded to provide technical support to these agencies and oversee a cross-site evaluation of this initiative

Description of Programs Programs are diverse in: Populations Served Structure of Interventions Intervention Approach

Primary Research Questions Does the program increase HIV-related risk perceptions and decrease or prevent HIV-related risk behaviors? Does the program increase substance abuse-related risk perceptions and decrease or prevent substance use- related behaviors?

Methods Quasi-experimental design: repeated measures with comparison group Data collected via a Cross-site Survey Instrument at: -baseline -3 months post-baseline -6 months post baseline 3 Versions of the Survey were developed for: (1) adults, (2) adolescents and (c) children

Methods Program and comparison participants will be compared on -major outcome variables mediating variables Moderating effects of demographic (e.g., race/ethnicity, age) and contextual variables (e.g., relationship violence, neighborhood risk) will be assessed

Measures Outcome Variables* -Sexual and IDU Risk Behaviors -Substance Use/Abuse Behaviors Mediating Variables -Sexual Risk Attitudes and Risk Perceptions -Substance Abuse Attitudes and Risk Perceptions * Not included in Children’s Survey

Measures Contextual Variables -Neighborhood Risk -Experiences of Racism -Power Disparities and Abuse in Relationships* Demographics -Gender-Education* -Age -Race/Ethnicity Included in Adult Survey Only

2695 Baseline Surveys Processed 385 Children Surveys -1,068 Adolescent Surveys -1,242 Adult Surveys Data for all time points is still being collected Data presented here are preliminary Preliminary Findings

Participant Profile Adult Adolescents Mean Age Gender % Female % Male Race % Black % Hispanic % Other

Language Spoken by Adolescent and Women Respondents Women Adolescents English mostly or only72.3%89.0% English & other equally18.2%17.9% Other mostly or only 9.5% 2.1%

Country of Origin WomenAdolescent Country/Origin U.S.*73.4% 88.4% Other 26.6% 11.6% * Continental US

*Adolescents: Sexual Risk Ever had sex 50.1% Mean age at first sex 13.2 years Used condoms at first sex 69.1% Had sex in past 3 months 65.3%* * Question asked only of those who were sexually active

*Sexually Active Adolescents in Past 3 Months Used Condom at Last Sex 48.9% Mean Number of partners 2.7 Had unprotected sex for $ 6.1% Had unprotected sex within HIV+ partner 1.3% Had unprotected sex with IDU 3.3%

*Women: Sexual Risk Ever had sex 95.7% Mean age at first sex 16.1 years Used condoms at first sex 29.6% Had sex in past 3 months 57.0%* * Question asked only of those who are sexually active

*Sexually Active Women in Past 3 Months Used condom at last sex 60.9% Mean number of partners 1.5 Had unprotected sex for $ 13.8% Had unprotected sex within HIV+ partner 2.7% Had unprotected sex with IDU 3.3%

Adolescents: Substance Use Ever smoked a cigarette40.6% Ever had a drink49.5% -In the past 30 days 30.4% Ever used marijuana34.8% -In past 30 days30.4% Ever used illicit drugs19.9% -Mean age at first use 13.1 years

Women: Substance Use Ever had a drink 69.5% -In the past 30 days 36.3% Ever used marijuana 40.7% -In the past 30 days 13.9% Ever used illicit drugs 36.4% -In the past 30 days 27.6% -Mean age at first use 19.3 years

Adolescents: Experiences of Racism Due to their race, in the past 6 months: Called insulting names 52.3% Monitored by security while shopping 54.6% Found it hard to keep/find a job 56.1% Stopped by police 18.8% Had their house vandalized 14.9% Were physically attacked 18.9%

Women: Experiences of Racism Due to their race, in the past 6 months: Called insulting names 43.8% Monitored by security while shopping 47.3% Found it hard to keep/find a job 49.3% Found it hard to get a loan 23.1% Refused housing 17.1% Stopped by police 19.9% House vandalized 9.1%

Women: Experience of Violence % *Past 3 months

Women: General Relationship Power Percent Partner:

Women: Relationship Power in Condom Use Percent Believe partner will:

Conclusions The CSAP Minority AIDS Initiative is reaching the community based agencies and populations for which it was intended Implementation process had demonstrated growth in capacity to implement HIV interventions and evaluation

Contextual Factors: Racism Experience of racism was reported by a significant proportion of participants. Reports of victimization among women were high. Compared to Hispanic women, African American/Black women were especially at risk for experiencing abuse from other than current partners.

Contextual Factors: Violence For approximately 1 in 4 or 1 in 5 women participants, lack of power in their primary relationship affected their ability to make free decisions and choices 1 or 2 in 10 women expect a serious negative response from their partner if they request condom use

Implications Informing the field about adaptations of evidence based HIV prevention approaches Advancing the knowledge base on the role of contextual factors in HIV risk among communities of color Lessons learned about capacity building and implementation within CBO’s