Jpgrund beyond hiv-sofia


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Jpgrund beyond hiv-sofia

  1. 1. Social Inclusion and Health – Crossing the Borders Sofia, September 27-29, 2007
  2. 2. Beyond HIV: The Peer Driven Intervention and Empowerment of Vulnerable Populations J-PC Grund & D. de Bruin
  3. 3. In fond memory of Nico Adriaans
  4. 4. A personal timeline (i)  1970-1980 NL: Rising drug use, urban scenes, mild repression, abstinence-only, policy makers ignorant, prerogative of policy @ psychiatrists and social workers;  1980: Rotterdamse Junky Union (RJB), Nico Adriaans, Raising Hell, challenging politics, making voices heard (press strategy, Radio Junkiebond), Union Style self-organization;  1980s: Normalization policy, new generation policy makers, RJB guerilla methadone program, introduction of low-threshold methadone in Rotterdam, blooming chasing culture at house addresses; onset of decrease in injecting prevalence;
  5. 5. A personal timeline (ii)     1985-1988: HADON, community based outreach to IDUs, from methadone to needles, “sign of the times,” first needle exchange in Rotterdam; 1986: Client Zero, “collective exchange,” 1989: 60.000 (half of city’s) needles exchanged, natural organization in drug using networks; 1988-1993: Academia and back to the streets, observed “frontloading” and how hardening drug policy gave birth to crack, started to grasp the complexity of the streets, Drug use as a social ritual. Nico (CFW) was my eye opener, Charlie Kaplan made it all possible; 1993-1995: Go West, Group-Mediated-Social Control, the first peer driven intervention (PDI), Respondent Driven Sampling (RDS) in Ct, USA;
  6. 6. My experience with self-organization     Union Style self-organization, “fight (and negotiate) the power,” guerilla activism, immediate cause important (street user more prone to activism than methadonian), questions about sustainability, cooptation; Service provider to clients; Natural organization: IDU networks organized around critical commodities (drugs, needles, etc.), supplied by service provider (excl. drugs of choice) A shot of mathematical sociology: how we all use our influence to serve our needs, economically, bio-socially, information-wise…
  7. 7. A personal timeline (iii)   1995-2003: Go East, main occupation harm reduction policy stuff in CEE; Part-time researcher: 1995: “A heroin epidemic in Macedonia,” HOPS, Skopje  1999- 2000: Roma, drugs & HIV (disenfranchised community devoid of service provision);  1999- 2000: Needle exchange in CEE (Pskov, Yaroslavl);   All studies strengthened my conviction of the need for empowerment and peer-led strategies;
  8. 8. Pskov, 1999: Opiates
  9. 9. Pskov, 1999: Stimulants
  10. 10. Pskov, 1999: Response Both Pskov and also Yaroslavl (PDI) kept HIV under IDUS, in contrast with most of the rest of Russia, under control.
  11. 11. RDS & PDI: Theory and Practice   Group Mediated Social Control; From Theory to Practice Respondent Driven Sampling;  Peer Driven Intervention 
  12. 12. Group mediated social control   A theory about how people behave and influence (negotiate) each other in order to serve their needs, we have preferences regarding both our own and other people’s actions; Two sources of social influence: Individual sanction based control—primary incentives;  Group mediated social control—secondary incentives;   Example: The school class dilemma
  13. 13. Figure 1. The theory of Group-Mediated Social Control (Heckathorn, 1997) Individual Sanctionbased Control Sanctions can be both positive and negative Individual Sanction Group-Mediated Social Control Actor Agent Collective Sanction Intra Group Control (e.g. spill-over from individual Sanction) Actor’s Group
  14. 14. From Theory to Practice (i)  Network approach applying positive incentives: Primary Incentive for participation in intervention;  Secondary Incentive for engaging peers in intervention;   Recognizes that peers know best about peers, peers are better to convince peers than professional workers
  15. 15. From Theory to Practice (ii)  Research: Respondent Driven Sampling Peers are rewarded to convince their peers to join the study;  Modified snowball sampling;  Mathematical model, based on GMSC, allows for assessing and correcting bias: probability sample.  Coupon system for tracking and payment 
  16. 16. Figure 2. Respondent Flow in RDS Flow of incentives Flow of incentives Research Worker Peer 1.1 Peer 1 Community Research unit Peer 2 Research unit Peer 1.2 Community Seed 1 Research unit Peer Y Community Peer 1.Y Seed 2 Seed X Peer Y.1 Peer Y.2 Peer Y.Y Peer 1.1.1 Peer 1.1.2 X = No. of seeds; Y = 3-5 Peer 1.1.Y
  17. 17. What’s good for science… Question: how long does it take an outreach worker to get from… Sample composition stabilizes, reaching equilibrium independent of the choice of seeds. Recruitment by race/ethnicity, NYC drug users (Abdul-Quader et al., 2006) B A
  18. 18. From Theory to Practice (iii)  Intervention: Peer Driven Intervention Peers are rewarded to conduct the same tasks as outreach workers;  Primary incentive for participation in a series of health education sessions (accent on being taught);  Secondary incentive for engaging peers in intervention and educating them in the community (accent on teaching); 
  19. 19. Figure 3. Schematics of Intervention Exposure in a PDI and a TOI
  20. 20. Is “What’s good for science,” good for the People?  Peer driven intervention superior to traditional outreach work intervention in HIV prevention among IDUs:    The PDI significantly outperformed the TOI in education performance, recruitment power, representation, and in reducing risk behaviours, while being about 30 times less costly. Participants respond positively, rewarding contributes to selfesteem, stimulates networking and information flow, no noticeable effect on drug use. Repeated studies have supported findings
  21. 21. A personal timeline (iv)    2004: Ukraine: respondent driven sampling study of young IDUs and their non-injecting friends about transition into injecting drug use 2006: CVO research line: New applications for RDS and the PDI. 2007: The Hague Department of Public Health: WEB-RDS
  22. 22. RDS : new directions  WEB-RDS of 1500 Nightlife participants at The Hague Department of Public Health
  23. 23. PDI: new directions (iii)       Ukraine “transition into IDU” RDS study Initiation into IDU is peer-based social process, different for boys and girls, exposure to IDU events leads to curiosity, curiosity kills the cat… Follow up proposal: Peers Breaking the Cycle intervention (PDI), aiming to reduce the incidence of injecting drug use; Ukraine (Other countries?) Two target groups: young/recent IDUs, non-IDU friends; Two approaches:    Non-IDUs: social marketing PDI aiming to strengthen social norms against injecting; IDUs: PDI combining Break the Cycle & overdose prevention (Naloxone) Targets two of the gravest health concerns associated with (injecting) drug use: HIV & overdose
  24. 24. Conclusions (i)       Social theory supports community and peer based interventions; Innovation in intervention development is important; Group mediated social control is useful concept for community based interventions; Applied in various vulnerable (IDUs, non-IDUs, CSW, MSM) and less vulnerable populations (recreational drug users, nightlife participants, Jazz musicians); Participants respond positively to PDI & RDS; Peer driven interventions enhance self-esteem, engagement and “solidarity groups” (Heckathorn & Rosenstein, 2002).
  25. 25. Conclusions (ii)  Need to study GMSC applications in different populations and towards different intervention goals;     Netherlands: smokable cocaine users on the street; Ukraine (and elsewhere?): prevention of initiation of drug injecting Treatment PDI Is model useful for community organizing approaches in vulnerable populations?      Positive action Conveys useful ‘user knowledge’ & health information Rewarding Empowering Possible recruitment pool for community activism and other forms of organizing around health, social and human rights issues?
  26. 26. Contact Jean-Paul Grund T: +31302381495 E: W3:
  27. 27. Finally, Crossing the Borders…