Triple Stigma:Race, HIV, and Drug Use: Triple Stigma: Race, HIV, and Drug Use Danni Lentine, MPH Centers for Disease Control and Prevention June 21, 2007 HIV/AIDS and African American Women: A Consultation Supporting CDC’s Heightened National Response to the HIV/AIDS Crisis Among African Americans The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention


Topics: Topics Epidemiology of HIV for IDU Addictphobia & discussion of impact The Comprehensive Approach What is it Materials available


Slide5: Proportion of New Diagnoses Reporting IDU-related risks, By Race & Ethnic Groups, USA*, 2004 Injection drug use (IDU) Male-to-male sexual contact and IDU Sexual contact with IDU * 42 areas (37 states & 5 territories) with confidential name-based HIV infection reporting. SOURCE: adapted from tables 20 & 22 http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report/pdf/2004surveillanceReport.pdf 0% 5% 10% 15% 20% 25% 30% White Black Hispanic ALL 8.4% 4.5% 2.0% 10.0% 1.6% 2.7% 21.5% 2.4% 4.5% 11.9% 2.7% 2.9% 14.9% 14.7% 28.4% 17.5%


New IDU-Associated HIV (not AIDS) Cases Reported 2004, by Gender and Race/Ethnicity: New IDU-Associated HIV (not AIDS) Cases Reported 2004, by Gender and Race/Ethnicity SOURCE ADAPTED FROM: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report/pdf/2004SurveillanceReport.pdf


Proportion of New HIV and AIDS Cases Among Black Non-Hispanics in 2004, by Risk & Sex: Proportion of New HIV and AIDS Cases Among Black Non-Hispanics in 2004, by Risk & Sex Adapted from Supplemental Surveillance Report Cases of HIV Infection and AIDS in the United States, by Race/Ethnicity, 2000–2004, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006supp_vol12no1/default.htm


“Addictphobia” or “Junkyphobia”: “Addictphobia” or “Junkyphobia” Term used to describe negative attitudes toward, and misconceptions about, people who use drugs


Drug users are believed to be – : Drug users are believed to be – Criminals whose addiction represents a moral failing that should be punished rather than treated. Unwilling or unable to change their risk behaviors.


Graffiti – Washington D.C., 1999: Graffiti – Washington D.C., 1999


Neuroimaging Response: Neuroimaging Response MRI’s show increase activity in the Medial pre-frontal cortex (mPFC) when people think about others or themselves 10 Princeton University Undergraduates participated in study From: Harris, LT. & Fiske, ST. 2006. Dehumanizing the Lowest of the Low: Neuroimaging Responses to Extreme Out-Groups. Psychological Science, Vol.17, No.10, 847-853.


Neuroimaging Response: Neuroimaging Response No mPFC activity when shown pictures of addicts and homeless people Instead, area of the brain associated with disgust and fear increased in activity Scientific evidence supporting that addicts are seen as less than human, or dehumanized


Junkiephobia/AddictphobiaPunishment vs.Treatment: Junkiephobia/Addictphobia Punishment vs.Treatment Society’s attitude toward IDUs is illustrated by: Substantial investments in prisons and criminal justice vs. Relatively limited support for substance abuse treatment


Junkiephobia/AddictphobiaPunishment vs.Treatment: These societal attitudes toward drug users have limited the options for public health programs for drug users particularly HIV prevention among injection drug users. Junkiephobia/Addictphobia Punishment vs.Treatment


“Addictphobia”: Lack of drug treatment Reduced ability for public health to engage IDU Reduced political will to provide adequate funding and programs for IDU Reducing addictphobia is an important factor in our ability to improve the health of those who use drugs, including IDU “Addictphobia”


Junkiephobia/Addictphobia Possible Value of a Name: Junkiephobia/Addictphobia Possible Value of a Name The concepts of “racism” and “homophobia” have helped identify important social and individual factors that influence the success of prevention activities.


Stigma “Gallery”: Stigma “Gallery” HIV + Racism Homophobia Addictphobia


Proportion of HIV and AIDS Cases Diagnosed in 2004, by Risk & Sex: Proportion of HIV and AIDS Cases Diagnosed in 2004, by Risk & Sex Adapted from Supplemental Surveillance Report Cases of HIV Infection and AIDS in the United States, by Race/Ethnicity, 2000–2004, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006supp_vol12no1/default.htm


U.S. Public Health Service HIV Prevention Bulletin (1997): U.S. Public Health Service HIV Prevention Bulletin (1997) Persons who inject drugs should be regularly counseled to: I. Stop using and injecting drugs. II. Enter and complete substance abuse treatment, including relapse prevention. Source: adapted from: http://www.cdc.gov/idu/pubs/hiv_prev.htm


HIV Prevention Bulletin (2): HIV Prevention Bulletin (2) III. Take the following steps to reduce personal and public health risks, if they continue to inject drugs: Never reuse or “share” syringes, water, or drug preparation equipment. Use only syringes obtained from a reliable source (e.g., pharmacies). Use a new, sterile syringe to prepare and inject drugs. Source: adapted from: http://www.cdc.gov/idu/pubs/hiv_prev.htm


Comprehensive Approach: Comprehensive Approach


Publications: Publications Since 1998, Project has created 45 publications including: 4 “families” of fact sheets (3 translated into Spanish) A guiding framework document on the Comprehensive Approach Comprehensive Approach brochure


CDC HIV Prevention among IUDs Project: CDC HIV Prevention among IUDs Project


www.cdc.gov/idu: www.cdc.gov/idu


A Fact Sheet “Family” – “Parent”: A Fact Sheet “Family” – “Parent”


A Fact Sheet “Family” – “Kid 1”: A Fact Sheet “Family” – “Kid 1”


A Fact Sheet “Family” – “Kid 2”: A Fact Sheet “Family” – “Kid 2”


A Fact Sheet “Family” – “Kid 3”: A Fact Sheet “Family” – “Kid 3”


A Fact Sheet “Family” – “Kid 4”: A Fact Sheet “Family” – “Kid 4”


A Fact Sheet “Family” – “Kid 5”: A Fact Sheet “Family” – “Kid 5”


En Español: En Español


Chinese Translation : Chinese Translation


Fact Sheets: Fact Sheets


Outreach Web: Outreach Web


www.cdc.gov/outreach: www.cdc.gov/outreach


Improving HIV Prevention Outreach to IDU and others at Risk: Improving HIV Prevention Outreach to IDU and others at Risk Improving HIV Prevention Outreach What Does the Literature Say About Outreach? How Does Outreach Fit Into HIV Prevention? Outreach and CDC’s Advancing HIV Prevention Initiative Improving Outreach to Drug Users and Others at High Risk Training Outreach Workers Achieving the Goals of Outreach Outreach Models Issues in Organizing and Maintaining Outreach to Drug Users Keeping Track of Outreach Efforts Applying Lessons from Community Health Outreach Ensuring Appropriate Skills and Competencies Providing Training and Certification Planning and Developing Community Health Outreach Programs


Greater Dallas : Greater Dallas


New York City, New York: New York City, New York


Seattle WA: Seattle WA


Iran Outreach Team: Iran Outreach Team


Iran Outreach Team: Iran Outreach Team


Slide47: Thank You!!