Rural and Urban African American Cocaine Users' Perceived Need for Care

We seek to study the factors associated with rural/urban differences in perceived need for both drug abuse treatment and HIV testing because these are complementary services which could be integrated within formal drug abuse treatment programs or other locations to better meet the needs of African American cocaine users. We focus on perceived need among African American cocaine users because of their low rates of drug abuse treatment and HIV testing nationally as well as their demonstrated low perceived need for drug abuse treatment, high rates of risky sexual behaviors, and aversion to seeking HIV testing at local health departments in our prior research. Given that our prior natural history research did not include any urban areas, we do not know whether the low rates of drug abuse treatment and HIV testing among rural Arkansans are specific to rural residents (e.g., whether there is a disparity in access for rural African Americans) or whether urban African American cocaine users differ in other critical factors. To address these issues, we plan to conduct a community-based mixed methods study of African American cocaine users residing in rural and urban areas of Arkansas. Specifically, we propose a sequential mixed-method design, with qualitative key informant interviews conducted first (30 rural, 30 urban), followed by larger-scale, structured interviews (200 rural, 200 urban) using standardized instruments, pertinent measures from our prior rural health services and HIV research, and newly developed questions based on our initial qualitative work. Respondent-Driven Sampling (RDS), a variant of snowball sampling, will be used to identify and recruit participants. The primary aims of the study are: 1) Using qualitative methods, to describe rural/urban differences in pathways to drug use and drug use cultures, perceptions of access to drug abuse treatment and HIV testing, awareness and perceptions of what constitutes drug abuse treatment and HIV testing, and preferences for formal or informal drug abuse treatment and the site or location of HIV testing; 2) Using quantitative and qualitative methods, to compare and contrast rural and urban cocaine users’ perceived need for drug abuse treatment and HIV testing and key predisposing, enabling, health, and other factors which could impede or facilitate perceived need; and 3) Using quantitative methods, to investigate whether rural/urban differences in perceived need for drug abuse treatment and HIV testing are mediated by key predisposing, enabling, and health factors as well as treatment and testing awareness and preferences. The knowledge gained from this project will enable health policy makers, treatment program managers, and providers to make more informed decisions about how to encourage and facilitate the utilization of drug abuse treatment and HIV testing among African American cocaine users in the Southern U.S., an underserved and high risk population.