Good Practices
An indicated prevention programme involving street youth
Indicated programmes work with youth who are already involved in drug use and are likely involved in other risky activities. The aim of these programmes is to prevent further use or, more realistically, to reduce harms or consequences of use. The following is a project, the AIDS Evaluation of Street Outreach Project (AESOP) in San Francisco, that works with homeless, runaway street youth to try to prevent or reduce the consequences of injection drug use and risky sexual activity.
Description:
The first phase of the project was to have outreach workers go into the community and provide condoms, bleach and information to street clients. A storefront centre later opened to provide a place where more in-depth dialogue could take place on sexually transmitted diseases (STDs), drug problems and other concerns. Later, more materials were developed specifically for unique local youth subcultures. Focus groups representing and involving the local youth were used to create information material, media and activities for their peers. This resulted in designs for posters, t-shirts, condom packets and the production of a prevention video. Professional outreach workers as well as peers worked with the youth. In addition to providing information and support, the storefront centre offered free meals and showers.
The challenge of the intervention was to develop material specific to the different groups within the community. There were those [Deadheads] who responded to messages about protecting family members through safe behaviour. In contrast, there was a culture in the area [punk/squatter] that responded to messages directed at protecting yourself or simply on survival.
Although not directly related to the operation of the centre, there was also a youth needle exchange operating in the area, which informally shared information about what services were available in the community.
Results:
The evaluation of the intervention examined longitudinal changes in high-risk youths' behaviour in injecting drug use and in their sexual practices.
Focused subculture specific interventions were successful in reaching the hidden population of high-risk street youth. This was shown through an increase in the frequency of contact with the outreach worker and the number of referrals, as well as an increased likelihood of using a new syringe for the last injection.
The evaluation also suggests that peer recruitment was successful in locating and enrolling the youth. One finding was that the follow-up on referrals to youth to programmes that did not appear to have the same subcultural influence were not well attended by the youth.
The development of the needle exchange programme did increase the use of clean needles where there was a very high level of contact with the outreach worker. The results also showed the introduction of needle exchange did not have an impact on other referrals, which suggests that needle exchange can influence the youths IDU behaviour but cannot replace other outreach interventions.
Reviewer's Comments:
During the evaluation of this intervention, there were limitations noted that may have impacted on the results. There were population shifts by the street youth, increased police enforcement and unusually severe weather patterns that may have hampered youth in accessing the outreach services. In spite of these cautions, the authors indicate that the subcultural intervention did result in increased participation in high-risk reduction activities, however, there did not appear to be any impact on sexual behaviour.
In their conclusions, the authors indicate that further research was warranted in the areas of: following groups of youth; using more sensitive measures of risk behaviour and; developing more prevention initiatives for this high-risk youth population.
Reference:
The Impact of Intensive Outreach on HIV Prevention Activities of Homeless, Runaway, and Street Youth in San Francisco: the AIDS Evaluation of Street Outreach Project (AESOP) (1997); Gleghorn, Clements, Marx, Vittingoff, Lee-Chu, Katz.
Contact:
Alice Gleghorn, Ph.D.
San Francisco Department of Public Health -- AIDS Office
25 Van Ness Avenue
Suite 500
San Fransisco, CA 94102-6033
Source:
G. Roberts, et al., (2001). Preventing Substance Use Problems: A Compendium of Best Practices. Health Canada.