Participants were self-identified gay and bisexual males contacted via street-based HIV-prevention outreach sessions. Included are participants who mentioned any recent substance use (previous 30 days). All participants were men contacted in the Hollywood and West Hollywood areas of Los Angeles County, a 7-mile region that accounts for the highest concentration of annual AIDS cases in Los Angeles County12
and has a high density of gay and bisexual male residents.
Outreach Intervention Program
The street outreach HIV-prevention program provided low-intensity health education and risk-reduction interventions using teams of ethnically diverse, bilingual (English and Spanish), and indigenous street outreach workers. Over the entire 9-year period, prior to entering the field, outreach workers received 6 to 8 weeks of intensive training (from first author) and demonstrated proficiency in how to identify high-risk venues, establish trust and rapport, approach gay and bisexual men in sexually charged and/or drug intense settings, administer a brief assessment, and provide culturally appropriate referrals, when needed. Additionally, recruitment and intervention procedures used during street outreach were consistent throughout the 9-year period.
Teams of outreach workers canvassed areas known to be frequented by substance-using gay and bisexual males, including sex clubs, bars, bathhouses, cruising areas, parks, coffee houses, and specific street corners and alleys. Outreach activities were conducted by rotating teams between 11:00 a.m. and 5:00 a.m. Individuals who appeared to match the target population of gay and bisexual male substance users were approached by outreach workers who then conducted “encounters,” i.e., low-intensity HIV-risk-reduction interventions, that lasted from 16 to 60 min.
Using a unique identifier to ensure anonymity, outreach workers recorded participant responses on a brief instrument that assessed demographics (gender identity, sexual identity, age, race/ethnicity), self-reported HIV status, alcohol and other drug use in the previous 30 days (including injection and non-injection drug use), HIV drug-risk behaviors (injection practices), sexual behaviors in the previous 30 days (oral sex, insertive and receptive anal sex, vaginal sex), HIV sexual risk behaviors (frequency of condom use), and sexual partner type (male, female, pre-operative transgender, post-operative transgender, exchange partner). All data were self-reported. Outreach workers also recorded descriptive information on the encounter (e.g., duration, location, time of day, supplies given). Data included in this study are confined to demographics, HIV status, and substance use. Participants were not compensated for their participation.
This study reports only on responses from the first recorded encounter with a unique participant. The goal of the outreach encounter was to assess the participant’s level of drug use and sexual risk behaviors, provide low-intensity risk-reduction strategies, provide the participants with risk-reduction supplies (e.g., condoms and bleach) and survival kits (e.g., sunscreen, combs, razors, toothbrushes, and toothpaste), and provide referrals to needed services, if appropriate.
Reports from encounters were entered into electronic databases using scanners. Once captured into files, data were sequestered into 6-month periods. Duplicates for participants using the same anonymous code as well as those reporting no substance use were eliminated from these analyses. Cases with missing responses were deleted, yielding a database with only complete unduplicated cases.
Basic frequencies for each of the variables of interest were calculated. Frequencies for heroin, GHB, and ketaine, as well as for any injection drug use, were omitted due to their low rates. Demographic factors assessed included race/ethnicity (Caucasian/white, African American/black, Latino/Hispanic, multi-cultural/other), age (in years), and sexual identification (gay, bisexual, heterosexual). HIV status was measured as positive, negative, unknown, refused, or did not ask. All analyses were conducted using SPSS (Version 13.0).