Reaching and engaging non-gay identified, non-disclosing Black men who have sex with both men and women.

Non-gay identified (NGI) Black men who have sex with both men and women (MSMW) and who use substances are at risk of acquiring and transmitting HIV to their partners. Homophobic community norms can discourage such men from disclosing their risk behaviour to female partners and others, including service providers. It is important to understand the dynamics of risk in this vulnerable population, but research is challenged by the men's need for secrecy. In this paper we report on successful efforts to recruit 33 non-disclosing, NGI Black MSMW for in-depth interviews concerning substance use, HIV risk and attitudes toward disclosing their risk behaviour. We employed targeted and referral sampling, with initial contacts and/or key informants drawn from several types of settings in New York City, including known gay venues, community organisations, neighbourhood networks and the Internet. Key informant gatekeepers and the ability to establish rapport proved central to success. Perceived stigma is a source of social isolation, but men are willing to discuss their risk behaviour when they trust interviewers to protect their privacy and engage with them in a non-judgemental manner. Findings imply that the most effective prevention approaches for this population may be those that target risk behaviours without focusing on disclosure of sexual identities.

Gender differences in the distribution of cocaine and heroin in Central Harlem.

OBJECTIVE: This article investigates the extent to which users of crack, powder cocaine and heroin in Central Harlem participate in various roles involved in distributing these drugs, examining gender differences among distribution roles. METHODS: Several strategies were combined to acquire a sample of 655 hard drug users and sellers who self-reported demographics, drug use and other factors in a face-to-face interview. Chi-square analyses were used to examine factors associated with having drug distribution roles. RESULTS: More than two-fifths (N = 269) of all respondents self-reported participation in at least one current distribution role. The most common roles were acting as a middleman, steering buyers, holding drugs or money, and transporting drugs. Distributors were more likely to have HIV, previous drug treatments, and less education, employment or housing, but had higher incomes than users. A higher proportion of women reported drug distribution roles, but among distributors, men were twice as likely women to be direct sellers and transporters of drugs, and to perform more distribution roles. CONCLUSIONS: Gender contrasts support previous research indicating male dominance of drug distribution roles. Previous studies may underestimate women's participation in distribution roles. Drug treatment programs are encouraged to augment existing relapse prevention activities with distribution prevention efforts.

Characteristics of Hidden Status Among Users of Crack, Powder Cocaine, and Heroin in Central Harlem.

This article analyzes hidden status among crack, powder cocaine, and heroin users and setters, in contrast to more accessible users/sellers. Several sampling strategies acquired 657 users (N=559) and sellers (N=98). Indicators of hidden status were those who (1) paid rent in full in the last 30 days, (2) used nonstreet drug procurement. (3) had legal jobs, and (4) earned $1,000 or more in legal income in the last 30 days. Nearly half had at least one indicator: approximately 16% of users/sellers had two to four indicators. In logistic regression analyses, those who had not panhandled in the last 30 days, those who had used powder cocaine in the last 30 days, and those never arrested were the most likely to have hidden status, whether the analysis predicted those having any indicators or those having two to four indicators. The four indicators begin to operationally define hidden status among users of cocaine and heroin.

An enumeration method of determining the prevalence of users and operatives of cocaine and heroin in Central Harlem.

INTRODUCTION: The investigators estimated the number and characteristics of crack, powder cocaine and heroin users and distributors ("operatives") in Central Harlem. METHODS: Central Harlem was divided into 45 primary sampling units (PSUs) with 2 years of drug allegation data from the New York Police Department (NYPD) organized in three strata, those having high, middle or low levels of allegations. In nine randomly selected PSUs, interviewers employed chain referral sampling procedures that were steered by using a nomination technique. RESULTS: Within sampled PSUs, 657 respondents nominated 5756 others for a total of 6413. Seven indicators identified 1007 unique individuals among 2835 nominated by two or more respondents, totaling to 4585 unique persons. These drug users and operatives were divided by the total number of persons in these PSUs according to the 1990 census to estimate the number of drug users and distributors in the 36 PSUs not sampled and for all 98,725 residents of Central Harlem. Approximately 13.4% of Central Harlem residents were estimated to be users of crack, powder cocaine and/or heroin with no roles in drug distribution. Approximately 6.7% of Central Harlem residents were estimated to be operatives of these drugs, some of whom may also have been users. CONCLUSIONS: Enumeration techniques can be a basis for projecting prevalence estimates for crack, powder cocaine and heroin users and operatives in a large urban geographic area.

Detecting crack and other cocaine use with fastpatches.

A continuing social problem is presented by the large number of individuals who use crack cocaine. Recent research has identified unique pyrolysis products of crack or burned cocaine as anhydroecgonine methylester (AEME) and ecgonidine (ECD) through gas chromatography/mass spectrometry (GC/MS) that allow for the detection of crack use distinct from other cocaine use. However, there have been no large-scale studies to document the presence and prevalence of these substances in sweat. A new sweat-testing appliance called a fastpatch was developed for this study. Through mild heating and a slightly larger collection pad than a standard Pharmchek( trade mark ) sweat patch, this product shows the promise of shorter required wear periods than standard sweat patches, and possibly longer time-periods of detected use. One hundred and eighty subjects wore 360 fastpatch prototypes (one per hand). However, subsequent analysis determined that only one patch per subject was needed to obtain sufficient sweat eluate for GC/MS. Cocaine use was detected in sweat of 92% of subjects through GC/MS, comparing favorably with 91% with EMIT urinalysis. Crack metabolites were detected in 54% of subjects. The predominant analyte detected was AEME. There were no significant differences in detection rates between 15-, 20- and 30-minute wear periods. All wear periods detected both cocaine use in general and crack use successfully. These results suggest that crack use as distinct from other cocaine use can be detected in sweat and that fastpatches are a promising new way to detect drugs of abuse.