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