COUNSELING PROGRAMS

GENERAL PROGRAMS

Hawaii’s statewide SEP has shown positive results, greatly due to the counseling programs for addiction and education (Vogt et al. 1998). 74% of participants had not shared syringes one month prior to the follow up interview. This program, similar to New York’s current ESAP costs $625,600 annually, and if they are successful in preventing 5 new HIV infections per year the cost-benefit ratio is greater than 1, which saves money for the state. Counsel programs would include support systems along with education on HIV and prevention. How to properly clean needles after use, and location and laws of SEP should be included in education. Counseling could help change the attitudes of IDUs, a factor of needle sharing (Magura et al., 1989). While many IDUs are aware of the harm of needle sharing, they are not presented with proper support to assist in ending this behavior. A counsel group would set up a social network other than used for drugs, a social environment of drug users has been reported as a determinant of needle sharing. Social interactions where an entire network is IDU form ideas that injecting together and sharing needles is the norm (Davey-Rothwell & Latkin, 2007). Many first incidences with drugs occur while with experienced IDU, and require sharing needles and equipment, establishing the practice of using shared needles (Mandell et al.,1994). Conversations addressing the dangers of needle sharing that teach lower risk methods appear to change their perceived norms, possibly changing dangerous methods (Davey-Rothwell & Latkin, 2007). This study found that most HIV conversations among drug users occur while getting high, this type of communication provides the opportunity to practice safe injection methods while discussing them. Depression and other psychological burdens associated with drug use should be addressed during general counseling. Seeing as many IDUs are familiar with the risks of HIV and drug use, a fatalistic attitude has become prevalent (Magura et al., 1989). They perceive that their actions have already put them at risk for contracting HIV, so continue to share needles. Depression has proved to have a significant association with needle sharing, both with and without cleaning (Mandell et al., 1999). Depressed individuals may turn to drug networks for support, but in order to raise moods together they will inject drugs. One-on-one counseling in conjunction with group work could help overcome this type of behavior. One-on-one work could address what is causing depression, while group work can provide a new network to turn to. Treating depressive symptoms has been seen to reduce high-risk behaviors (Mandell et al., 1999). Extreme measures can be made by the counsel workers to maintain returning clients. 56% of a sexual risk reduction intervention returned when extreme efforts were made to remind and entice them to attend another meeting (Senn et al., 2007). These included phone calls, invitations to return, lunch, stipends, an approachable and diverse staff, as well as convenient and familiar locations.

SPECIFIC PROGRAMS

While general counseling can help deal with behaviors related to IDU, more specific counseling should also be available for Black IDUs and for each gender. The history of the Black community and Public Health, especially because of the Tuskegee Syphilis Study from 1932-1972, has resulted in a mistrust of the Black community regarding health issues. This study was a collaboration of governmental agencies to observe the natural course of Syphilis in the Black community of Macon County, Alabama (Thomas & Quinn, 1991). The government used local powerful organizations, such as schools and churches to gain support from the community. In order to preserve the results of the study, great lengths were taken to prevent the subjects from seeking treatment after the discovery that antibiotics cures Syphilis. One consequence of the Tuskegee Study is the Black community believing Public Health to give misinformation to the community. Ways to circumvent the mistrust between the community and the officials are presented as using trusted community members to disseminate HIV information, use incentives to continue attendance to interventions, and health services. Results may be increased if existing trusted community organizations work with Public Health to spread awareness about HIV and SEP. Some believe that SEP have been established to worsen the drug problems within Black communities. One study (Klonoff & Landrine, 1999) has looked at a Californian Black community and examined the prevalence of the belief that HIV has been made by the government as a form of genocide. A survey was delivered door-to-door with a $10 stipend asking if they agree with the statement HIV/AIDS was created by the government to wipe out the Black race, then to what extent they experienced racist events. 27% of the population agreed with the statement regarding the creation of the virus; men and women have different predictors as to why they believe this. Women are most likely to agree with this because of cultural traditions, while racial discrimination was the predictor for men. This shows the need for cultural tailoring of counseling and education for Black communities, as well the differences in reasons for using between men and women. Men’s education programs should focus more on HIV facts than women’s, women correctly answered more questions than men (Freeman et al., 1994). However, women’s clinics should focus on the expectations and consequences of dating an IDU. Females were more likely to shoot up with their partner than males, 50% of women shoot up with their partners compared to 21.5% of males, and were injected by males after he injected himself. Researchers suggest training women in conversation as how to go about negotiating sexual and drug behaviors. Men were more likely to shoot up by themselves, showing the effect social networks have on women, only 16.2% of men said the had never shot up alone in the previous 6 months, while 28% of women had not.

OTHER FORMS OF COUNSELING

Some IDUs may be hesitant to attend or believe counseling programs, suggesting the need for peer leaders. One study conducted in Baltimore, Maryland (Latkin, 1998) asked IDUs to elect peer leaders from the community, they could be anyone who drug users would listen to about prevention. The elected members of the community were asked to come in for training, list names of their drug and support networks members. The training was made up of 10 90-minute sessions where they were taught social norms and influences and how to resolve them within the community, they were paid $10 for each session attended. Upon completion of their training, leaders went out educate people, in whatever location they are most comfortable. They were encouraged to educate within their networks, as they might have more influence within groups where they have established trust and relationships. This type of intervention yielded positive behavioral changes for the participants and network members. Prior to education sessions, 16 % of the peer leaders cleaning their needles with bleach all of the time, after 59% reported cleaning. This change was seen among the drug network members, 80% said they never shared needles without bleach cleaning. Peer leadership appears to be positively effective on the community, is more cost-effective than traditional counseling, peers may have more of an influence than outsiders, can penetrate hard to reach users, and provide social support for the leaders. Religious congregations provide a comfortable and familiar location, as well as trusted preachers, who are can provide support and information to their congregations (Health Reference Center, 2007). Here, the church is seen as a place that should provide psychological and help maintain self-esteem. This should include providing support to HIV/AIDS victims as well as drug users. However, nearly 50% of New York City congregations do not have any forms of HIV awareness programs (Tesoriero et al., 2000). Many congregations located in areas that have been identified as high need did not see the need for HIV services. Catholic congregations were 3 times as likely to provide HIV services than Jewish communities, while Protestant congregations were 2.3 times more likely than Jewish communities. Congregation size was related to providing service or referrals; the larger congregations supplied more referrals. Predominately Black congregations were 4.5 times as likely than White congregations to report a high need for programs, showing they are aware of, but may not know how to properly address drug and HIV issues.