DESIGN OF BEHAVIORAL INTERVENTIONS FOR INJECTION DRUG USERS PROMOTING NEEDLE EXCHANGE USING COGNITIVE-BEHAVIORAL THEORY |
Titus, Stephen P*, Marmor M*, Harrison C*, Des Jarlais D**. *NYU Medical Center, New York, NY, USA; **Beth Israel Medical Center, New York, NY, USA.
Objective: Recent research evaluating the impact of needle exchange programs (NEPs) has found an overall beneficial impact on HIV-related risk behavior and on HIV-seroincidence. This study examines the framework of the Theory of Reasoned Action (TRA) to guide future behavioral interventions aimed at increasing use of NEPs among New York City injection drug users (IDUs).
Methods: An open-ended questionnaire based on the TRA was interviewer administered to 436 injection drug users (67.4% male, 32.6% female; 22% Caucasian, 32% African American, 46% Hispanic; median age=40 years, range 23 to 67; median years of education=12, range 3 to 18) between November 1994 and May 1995. The responses were coded and checked for reliability of the coding procedure. Perceptions were compared between NEP users and non-users who reported IDU in the prior 3 months.
Results: IDUs who use NEPs had different perceptions of the program than persons who are injecting and have not used NEPs. Non-users of NEPs were more likely to report that structural barriers, e.g., hours/location and having a more convenient source for needles, deterred their NEP use (88.1% vs. 35.8%). Non-users of NEPs were less likely to report: (1) perceived advantages of NEPs (3.4% vs. 25.8%, e.g., availability of clean/free needles, condoms, bleach, acupuncture, counseling or referrals at the NEP), (2) perceived social approval for NEP use (62.7% vs. 78.3%), and (3) an intention to utilize NEPs in the future (47.6% vs. 88.5%). Eighteen percent of non-users had never heard of NEPs and were subsequently provided with NEP information during risk reduction counseling.
Conclusions: In order to optimize the utility of NEPs in preventing HIV infection, health educators will need to foster positive community norms and perceptions of NEPs. Policy makers will need to address structural barriers that hinder the efficiency of NEPs in the community. Tailored interventions using the TRA framework may facilitate use of NEPs by changing inappropriate beliefs, perceived negative norms and structural barriers.
Stephen Titus, NYU Medical Center, 341 E. 25th Street, #236, New York, NY 10010-2598
Telephone: 212-263-6092
Fax: 212-263-1095
E-mail: stephen.titus@ccmail.med.nyu.edu
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