NIDA Research Monograph Series #157: Qualitative Methods in Drug Abuse and HIV Research

276 Pages·1995·0.64 MB·English

by  Lambert, Elizabeth Y. (editor), Ashery, Rebecca S. (editor), Needle, Richard H. (editor)

National Institute on Drug Abuse
RESEARCH
MONOGRAPH SERIES
Qualitative Methods
in Drug Abuse and
HIV Research
157
U.S. Department of Health and Human Services • Public Health Service • National Institutes of Health

Qualitative Methods in Drug
Abuse and HIV Research
Editors:
Elizabeth Y. Lambert, M.Sc.
Rebecca S. Ashery, D.S.W.
Richard H. Needle, Ph.D., M.P.H.
NIDA Research Monograph 157
1995
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
National Institute on Drug Abuse
Division of Epidemiology and Prevention Research
5600 Fishers Lane
Rockville, MD 20857
ACKNOWLEDGMENT
This monograph is based on the papers from a technical review on
“Qualitative Methods in Drug Abuse and HIV Research” held on July 19-
20, 1994. The review meeting was sponsored by the National Institute on
Drug Abuse.
COPYRIGHT STATUS
The National Institute on Drug Abuse has obtained permission from the
copyright holders to reproduce certain previously published material as
noted in the text. Further reproduction of this copyrighted material is
permitted only as part of a reprinting of the entire publication or chapter.
For any other use, the copyright holder’s permission is required. All
other material in this volume except quoted passages from copyrighted
sources is in the public domain and may be used or reproduced without
permission from the Institute or the authors. Citation of the source is
appreciated.
Opinions expressed in this volume are those of the authors and do not
necessarily reflect the opinions or official policy of the National Institute
on Drug Abuse or any other part of the U.S. Department of Health and
Human Services.
The U.S. Government does not endorse or favor any specific commercial
product or company. Trade, proprietary, or company names appearing in
this publication are used only because they are considered essential in the
context of the studies reported herein.
National Institute on Drug Abuse
NIH Publication No. 95-4025
Printed 1995
NIDA Research Monographs are indexed in the Index Medicus. They are
selectively included in the coverage of American Statistics Index,
BioSciences Information Service, Chemical Abstracts, Current Contents,
Psychological Abstracts, and Psychopharmacology Abstracts.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Elizabeth Y. Lambert, Rebecca S. Ashery, and Richard H. Needle
Qualitative Research Methods in Drug and AIDS Prevention Research:
An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Robert G. Carlson, Harvey A. Siegal, and Russel S. Falck
The Role of Qualitative Research in the Global Programme
on AIDS at the World Health Organization . . . . , . . . . . . . . . . . . . . . . 27
Kevin R. O’Reilly
Drug Use, AIDS, and Ethnography: Advanced Ethnographic
Research Methods Exploring the HIV Epidemic . . . . . . . . . . . . . . . . . 38
Robert T. Trotter, II
Determining Drug Use Patterns Among Women: The Value of
Qualitative Research Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Claire Sterk-Elifson
Applying the Methodology of Participant Observation
to the Study of Injection-Related HIV Risks . . . . . . . . . . . . . . . . . . . 84
Stephen Koester
The Daily Life of Heroin-Addicted Persons:
The Biography of Specific Methodology . . . . . . . . . . . . . . . . . . . . . . 100
Charles D. Kaplan and Elizabeth Y. Lambert
Hitting a Moving Target: The Use of Ethnographic Methods
in the Development of Sampling Strategies for the Evaluation of
AIDS Outreach Programs for Homeless Youth in New York City . . 117
Michael C. Clatts, W. Rees Davis, and Aylin Atillasoy
Using Focus Groups in Drug Abuse and HIV/AIDS Research . . . . . 136
Michele G. Shedlin and Janet Mogg Schreiber
Qualitative Research Considerations and Other Issues
in the Study of Methamphetamine Use Among Men
Who Have Sex With Other Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
E. Michael Gorman, Patricia Morgan, and Elizabeth Y. Lambert
iii
Team Research Methods for Studying Intranasal Heroin Use
and Its HIV Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Lawrence J. Ouellet, W. Wayne Wiebel, and Antonio D. Jimenez
Multimethod Research from Targeted Sampling to
HIV Risk Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Ricky N. Bluthenthal and John K. Watters
Ethnography and the Evaluation of Needle Exchange in the
Prevention of HIV Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Merrill Singer, Nancy Romero-Daza, Margaret Weeks, and
Pushpinder Pelia
iv
INTRODUCTION
Elizabeth Y. Lambert, Rebecca S. Ashery, and
Richard H. Needle
In July 1994 the National Institute on Drug Abuse (NIDA) sponsored a
technical review entitled “Qualitative Methods in Drug Abuse and HIV
Research.” It represents a continuing advancement in research
methodologies for understanding and intervening in the related epidemics
of drug abuse and HIV. The technical review benefits in both timing and
content from earlier NIDA-sponsored technical reviews, including “The
Collection and Interpretation of Data from Hidden Populations” (Lambert
1990) and “Acquired Immunodeficiency Virus (AIDS) and Intravenous
Drug Use: Future Directions for Community-Based Prevention
Research” (Leukefeld et al. 1990). The former addressed the application
of qualitative research methods in studies of drug abuse among hard-to-
reach populations, while the latter emphasized the use of qualitative
methods in the study of HIV/AIDS risk behaviors at the individual, social
group, and community levels. Since these technical reviews, the
epidemics of drug abuse and HIV have continued as major public health
threats, and the research community has been responsive to their
changing nature and to the evolving science. There is now a much
greater demand for creativity and resourcefulness on the part of
behavioral and social science researchers to expand and integrate
traditional research methods and develop new approaches to meet these
challenges.
The important role of qualitative methods in understanding the dynamic
nature of drug abuse and HIV has now become evident from their use in a
variety of studies, including NIDA’s Cooperative Agreement for AIDS
Community-Based Outreach/Intervention Research Program. In 1994,
principal investigators involved in this multisite research program, all of
whom have long recognized the indispensability of qualitative methods in
conducting drug abuse and HIV research, proposed that NIDA sponsor a
technical review entirely devoted to qualitative methods-what they are,
what they are used for, their appropriateness to different settings, and
their strengths and limitations.
For the technical review, participants were asked to prepare their
presentations from a qualitative methodologist’s perspective and to
address a number of specific issues, including:
How they define and develop the scope of qualitative research:
Their methods for subject sampling and recruitment;
How they handle ethical issues, including privacy and confidentiality
of sensitive information;
Their practices regarding use of remuneration and incentives;
How they select, train, and provide for the security of their field
researchers;
The cultural and other barriers they encounter in conducting their
field research;
How they process, verify, analyze, and interpret qualitative data; and
How they resolve issues that arise when combining qualitative and
quantitative methods in their research.
The chapters in this monograph are organized by the order of papers
given in the technical review. Robert Carlson’s overview of qualitative
methods in drug abuse and AIDS prevention research was the first
presentation. Kevin O’Reilly followed with an international perspective
on the role of qualitative methods in HIV/AIDS prevention research from
the standpoint of the Global Programme on AIDS at the World Health
Organization. The technical review then shifted its focus to specific
methodologies and their applications. Robert Trotter, II discussed
advanced ethnographic research methods for exploring drug use and the
HIV/AIDS epidemic, Claire Sterk-Elifson addressed the value of
qualitative research methods for determining drug use patterns among
women, Stephen Koester described the application of participant
observation to the study of injection-related HIV risks, and Charles
Kaplan examined the biography of a specific methodology in exploring
the daily life of heroin-addicted persons.
The second half of the technical review continued the themes of the first,
with a presentation by Michael Clatts on the use of ethnographic methods
in the development of sampling strategies for the evaluation of AIDS
outreach programs for homeless youth in New York City. This was
2
in the development of sampling strategies for the evaluation of AIDS
outreach programs for homeless youth in New York City. This was
followed by Janet Schreiber’s presentation of a paper coauthored with
Michele Shedlin on the use of focus groups in drug abuse and HIV
research. Michael Gorman then examined qualitative research
considerations and other issues in the study of methamphetamine use
among men who have sex with other men, Lawrence Ouellet described
team methods for studying intranasal heroin use and its HIV risks, Ricky
Bluthenthal discussed multimethod research from targeted sampling to
HIV risk environments, and Merrill Singer gave a presentation on
ethnography and the evaluation of needle exchange in the prevention of
HIV transmission.
Each technical review presentation was wholly unique, yet each
addressed the common objective of improving what is known about drug
abuse and multiple risk behaviors associated with the spread of HIV. In
so doing, each also demonstrated the significance of qualitative methods
for preventing disease and promoting public health.
At the conclusion of the technical review meeting, participants identified
several key recommendations for advancing drug abuse and HIV
prevention research. Some of these are evident from the individual
chapters, but they are summarized here to provide a framework and
direction for future research.
The first recommendation concerns advancing the state of the art for
conducting research about drug abuse and HIV prevention research
among marginalized and hidden populations. Theoretical and
methodological research paradigms should be expanded wherever
possible to incorporate multiple quantitative and qualitative methods.
Methodological choices must be based upon the research question(s)
under study, but such choices can be strengthened by triangulation; that
is, the sequential or concurrent use of qualitative methods will inevitably
improve the validity, generalizability, and confidence in research findings
and their implications for prevention.
Second, to ensure that research applications that utilize behavioral and
social science theories and methodologies receive the recognition they
deserve from other scientific disciplines and professions, it is the
responsibility of researchers-that is, of anthropologists, psychologists,
and sociologists-to communicate and disseminate their research findings
3
to a wide audience, in academic settings and conferences, in books, and
in peer-reviewed journals.
Finally, there are currently too few social scientists with the requisite
methodological expertise for the study of complex human behaviors
related to drug abuse and HIV prevention. For example, the HIV
epidemic disproportionately affects racial and ethnic minorities and
women, yet there are comparatively few minority or women investigators
in the research field. Thus, there is an immediate need to stimulate the
interest, commitment, and dedication of a new generation of ethnographic
and qualitative researchers to the study and prevention of drug abuse,
HIV, and AIDS.
REFERENCES
Lambert, E., ed. The Collection and interpretation of Data from Hidden
Populations. National Institute on Drug Abuse Research Monograph
98. DHHS Pub. No. (ADM)90-1678. Washington, DC: Supt. of
Docs., U.S. Govt. Print. Off., 1990.
Leukefeld, C.; Battjes, R.; and Amsel, Z., eds. AIDS and Intravenous
Drug Use: Future Directions for Community-Based Prevention
Research. National Institute on Drug Abuse Research Monograph 93.
DHHS Pub. No. (ADM)90-1627. Washington, DC: Supt. of Docs.,
U.S. Govt. Print. Off., 1990.
AUTHORS
Elizabeth Y. Lambert, M.Sc.
Health Statistician
Community Research Branch
Division of Epidemiology and Prevention Research
Rebecca S. Ashery, D.S.W.
Public Health Analyst
Prevention Research Branch
Division of Epidemiology and Prevention Research
and
4