This dissertation research used mixed methods to provide a thorough assessment of the individual, structural, and contextual barriers and facilitators to HIV testing among rural African American cocaine users, and to integrating HIV testing in substance abuse treatment and other community locations from the perspectives of drug users and providers. Such knowledge is especially needed in the rural South, where the HIV epidemic is growing rapidly. To accomplish this, qualitative methods were used to interview and conduct focus groups with 69 rural African American cocaine users, and 28 administrators/policymakers at the state level, regional program administrators, and local front-line providers. A secondary analysis was also conducted of baseline data from a clinical behavioral trial among 261 rural African American cocaine users. Assumptions about testing and errors in understanding of the reporting process were evident among our sample in the qualitative interviews and focus groups. Many assumed that they had been tested for HIV as part of routine care. They further assumed their test results were negative because they were not contacted by a provider about results. Interviews with providers revealed that HIV testing was not provided by substance use program staff in any of facilities in the sample; clients were referred to the local public health unit if they requested testing. However, the capacity of local health units to provide testing for treatment program clients is limited. There is no state policy addressing HIV testing among drug users nor plans for integrating HIV testing with substance abuse or other services nor collaboration between systems to provide services. Analysis of secondary data from the behavioral clinical trial indicated HIV testing is positively and strongly associated with use of other healthcare and specialty services, and also with past incarceration. Risk behaviors, risk perception, or physical health status did not predict testing for HIV. This mixed-methods study provides rich contextual information about barriers and facilitators to HIV testing in this disproportionately-affected, under-resourced population and the practice realities of integrating HIV testing with substance abuse treatment in a small rural state with limited resources and capacity.
|Advisor:||Curran, Geoffrey M., Stewart, Katharine E.|
|Commitee:||Booth, Brenda M., Borders, Tyrone F., Mays, Glen P.|
|School:||University of Arkansas for Medical Sciences|
|Department:||Health Systems Research|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 74/06(E), Dissertation Abstracts International|
|Subjects:||Behavioral psychology, Public health|
|Keywords:||African-Americans, Cocaine, HIV testing, Rural communities|
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