This paper describes some of the efforts of an interdisciplinary research team investigating the transmission of human immunodeficiency virus (HIV), the causative pathogen associated with the acquired immunodeficiency syndrome (AIDS) and related conditions. The risk groups studied were injecting drug users and their sexual partners. Due to the clandestine nature of illicit drug use, we were faced with two interrelated problems: developing a scientific method to monitor the spread of the HIV infection among these drug users and their sexual partners, groups generally thought to be especially difficult to reach; and creating a health education intervention that would help stop the epidemic from spreading among this population and through them to other members of the community. The method we developed to sample injecting drug users is called targeted sampling. Although it incorporates some aspects of other well established sampling strategies, it is sufficiently different to be treated as a separate research method. Further, targeted sampling provides a cohesive set of research methods that can help researchers study health or social problems that exist among populations that are difficult to reach because of their attributed social stigma, legal status, and consequent lack of visibility.

Targeted sampling: options for the study of hidden populations

Drug use and drug trafficking are examined as etiological factors in the creation of violence. A conceptual framework is presented for examining the drugs/violence nexus. Drugs and violence are see...

The Drugs/Violence Nexus: A Tripartite Conceptual Framework:

Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the United States. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses: A criminalizing morality versus a medicalizing model of addiction- as-a-brain-disease. Treatment in this context becomes a hostile exercise in disciplining the unruly misuses of pleasure and in controlling economically unproductive bodies. Most of the biomedical and epidemiological research literature on methadone obscures these power dynamics by technocratically debating dosage titrations in a social vacuum. A fou- caultian critique of the interplay between power and knowledge might dismiss debates over the Swiss experiments with heroin prescription as merely one more version of biopower disciplining unworthy bodies. Foucault's ill-defined concept of the specific intellectual as someone who confronts power relations on a practical technical level, however, suggests there can be a role for political as well as theoretical engagement with debates in the field of applied substance abuse treatment. Meanwhile, too many heroin addicts who are prescribed methadone in the United States suffer negative side effects that range from an accentuated craving for polydrug abuse to a paralyzing sense of impotence and physical and emotional discomfort.

/pdf/disciplining-addictions-the-bio-politics-of-methadone-and-1juakvwcst.pdf

Disciplining addictions: the bio-politics of methadone and heroin in the United States.

OBJECTIVE: Since 1985, community outreach efforts to combat acquired immunodeficiency syndrome (AIDS) among injecting drug users (IDUs) in the United States have overwhelmingly depended on a provider-client model that relies on staffs of professional outreach workers. We report on a comparison of this traditional outreach model with an innovative social network model, termed "a peer-driven intervention" (PDI). The latter provides IDUs with guidance and structured incentives that permit them to play a much more active role in the outreach process, thereby harnessing peer pressure on behalf of human immunodeficiency virus (HIV) prevention efforts. METHODS: We compare the performance of a traditional outreach intervention (TOI) and a PDI that were implemented in medium-sized towns in eastern and central Connecticut. Comparisons are based on the number and representativeness of IDUs recruited at each site, the effectiveness of HIV prevention education, compliance rates with AIDS risk reduction recommendations, and relative cost. The analyses are based on 522 initial interviews and 190 six-month follow-up interviews conducted during the first two years of each intervention's operation. RESULTS: Both interventions produced significant reductions in HIV risk behaviors, as measured using self-reports. The PDI outperformed the traditional intervention with respect to the number of IDUs recruited, the ethnic and geographic representativeness of the recruits, and the effectiveness of HIV prevention education. In addition, the costs of recruiting IDUs into the intervention and educating them about HIV in the community was only one-thirtieth as much in the PDI as in the traditional intervention. CONCLUSIONS: The findings suggest that given guidance and nominal incentives, IDUs can play a more extensive role in community outreach efforts than the traditional model allows. The findings also suggest that both interventions reduce HIV-associated risk behaviors, but the PDI reaches a larger and more diverse set of IDUs, and does so at much less expense.

/pdf/harnessing-peer-networks-as-an-instrument-for-aids-3r6bjfy108.pdf

Harnessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention.

The Internet and electronic mail 
increasingly offer the research community opportunities that it did not previously have. 
Access to information has increased as has access to and discussion with those working 
in similar areas. One other aspect of 'cyberspace' which presents enormous possibilities 
to the research community, currently in its infancy, is the use of the Internet to reach 
individuals as research subjects. In particular, there may be significant research benefits 
to be gleaned where the group being researched is normally difficult to reach and/or the 
issues being researched are of a particularly sensitive nature. This paper outlines some 
recent survey research using the Internet as the interface between researcher and 
researched. The target group, illicit 'drug dealers', are difficult to access under normal 
conditions and contacting a spread of such individuals across international borders was 
previously prohibitive. A discussion of sampling issues is undertaken which concludes 
that the Internet can be a valuable source of indicative as opposed to easily generalizable 
data. A practical guide to undertaking research via the Internet is also included.

https://journals.sagepub.com/doi/pdf/10.5153/sro.73

Using the Internet for Survey Research

(1969). Taking Care of Business—The Heroin User's Life on the Street. International Journal of the Addictions: Vol. 4, No. 1, pp. 1-24.

John J. Casey

Papers

Taking Care of Business—The Heroin User's Life on the Street