AIDS Partnership California

African American Sex Workers and Substance Users

CAL-PEP and Tranquilium Center, Oakland and Richmond, CA

CAL-PEP

Findings > CAL-PEP

Target audience

CAL-PEP serves primarily African Americans, sex workers, drug users and homeless persons in Alameda County, CA. Tranquillium serves primarily yout with HIV in Richmond, CA. For the P3 project, CAL-PEP and Tranquillium focused on African American sex workers (current or former) and drug users with HIV. These clients also may experience homelessness, mental health concerns and domestic violence.

Why African American sex workers and drug users?

In Alameda County in 2000, 57% of all AIDS cases were among African Americans.
In 2000, 31% of all new AIDS cases were among heterosexuals and 13% among IDUs.
Of the IDU cases, 73% were among African Americans.
CAL-PEP has a 17-year history of serving sex workers at risk for HIV infection.

Findings about clients

CAL-PEP and Tranquillium conducted 24 key informant interviews with the following results:

95% were in primary care (taking medications and/or going to provider visits)
Reported modes of transmission were
- 40% unprotected sex
- 20% IDU
- 20% MSM
- 20% unsure - either unsafe sex or drug use
85% felt comfortable discussing their HIV status with main sex partners.
Over 50% said they did not use condoms with their main partner if their partner had HIV.
All who reported having an HIV- main partner used condoms.
40% reported former or current sex work, and all of those used condoms with their "johns" or customers.
Over 25% reported speaking to young people about having HIV in schools and churches.
Half of the women felt comfortable disclosing their status to friends or loved ones, whereas 83% of the men had already disclosed.

Findings about prevention programs

HIV prevention messages need to be more visible and "real."
- Messages should be in places where regular folks go, such as grocery stores, post offices, beauty supply/barber shops and in high-risk social networks.
- Messages should be more "real" and graphic about what it's like to have HIV/AIDS.
- Participants mentioned smoking ads, "HIV stops with me" and "it could happen to me" ads as being effective.
More outreach should be done to people who don't know their status.
persons with HIV should be trained to speak at various venues and deliver prevention messages. Many believed that when they speak about getting HIV, they can prevent even one person from becoming infected.
When asked what was the one thing that could have helped in keeping them from becoming infected, 83% said abstinence and safer sex/safer drug use.

Next steps

Move toward integrated services model for CBOs.
Further explore P3 programming to those who are less informed (clients tend to know more).
Further explore the idea of realistic portrayal of HIV within a cultural context.
Explore social marketing campaign: "Do you have HIV What are you doing to find out? To prevent giving/getting HIV?"
Continue with support, technical assistance and evaluation via APC and others.
Continue with collaborations.

Lessons learned in research

Participants were very honest in answering intimate questions and were candid about their family and personal lives.
Participants were eager to come to individual interviews-we exceeded recruitment goals.
Using existing outreach staff for referrals and calling participants several times to remind them of their appointments helped in recruitment.

Client quotes:

"My partner hates using condoms, so sometimes we don't. At first it was like, since we both have it [HIV], let's just do it [have sex]. I learned that we may have different strains and could infect each other worse."
-Male, 41 years old, HIV+ 11 years

"I don't think they are strong enough messages [pharmaceutical ads]. They don't grab you. They need to stand out more and grab you.
-Female

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