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Young injection drug users (IDU) are at high risk for viral infections, such as HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV), due to frequent injecting, needle/syringe and other drug preparation equipment sharing, high numbers of sexual partners, and exchange of sex for money or drugs. Street youth who inject have high unemployment, poor education, and mental health issues. In San Francisco, young IDU are typically homeless runaways who often are involved in an illegal street economy, including prostitution, drug sales, theft, panhandling, pornography and selling stolen property. They experience a large number of negative and traumatic events prior to leaving home. Many fear and mistrust authority and consequently avoid or delay contact with the public health system. The combination of youth, drugs, survival sex and disenfranchisement make this group extremely vulnerable to multiple negative health outcomes.

Physicians, researchers, public health practitioners and patients are deluged with unmanageable amounts of information about the best approaches to prevention, treatment and health care delivery. Over the last 30 years, there has been an exponential rise in the number of published scientific articles across health fields. There have been 131,000 randomized controlled trials (RCTs) completed since 1948,1 over 2 million articles are published annually in the biomedical literature in over 20,000 journals,2 and over 3,330 journals are indexed in MEDLINE.

Because of threats to government funding, community based organizations that provide HIV prevention programs diversify their sources of income by seeking non-governmental funding, including funding from foundations. This survey of foundations across the United States asked questions about the amount of money they spend on AIDS and HIV prevention, the types of prevention projects and populations their grants served, and the sources of AIDS information used by the foundation staff. The results were then compared to the types of projects known to be effective and to the populations most at risk for HIV infection. These organizations funded a diverse range of HIV prevention programs, with a total of 583 grants worth over $8.1 million. This represents almost a quarter of all AIDS-related funding by foundations in the United States.

• HIV prevention grants represented 52% of all AIDS-related grants
• The average HIV prevention grant was for almost $14,000, ranging from $750 to $1.4 million.
• Public policy, capacity building, outreach and technical assistance were among the most frequently funded HIV prevention programs.
• Some useful HIV prevention programs, such as condom distribution and needle exchange, were rarely funded. • Women and youth received 25% of the funding for HIV prevention.
• More grants targeted the general population than drug users, gay men or ethnic minorities, although these groups contain more people at risk for HIV infection.
• Print media, site visits and colleagues were the main sources of AIDS related information for funders.
• Better sources of information are available to help funders gauge the effectiveness of proposed programs.
• Several factors (such as using culturally relevant language, providing creative rewards for participants, designing flexible programs and creating a forum for open discussion) that make HIV prevention programs more effective are provided for use when evaluating programs.

Action Point Center is a storefront medication adherence program for homeless people with HIV. Most clients also suffer from mental illness and/or substance use. Program components include: medication storage/dispensing, pharmacist consultation, acupuncture, adherence devices, monetary incentives, case management, and nursing services. Action Point is independent of any health care facility. Clients receive primary HIV care from a wide variety of providers in both community and private clinic settings. Action Point is a collaborative effort between the Department of Public Health and the San Francisco AIDS Foundation. (posted 4/03)

• Action Point Program Manual
• Action Point Proceedures Manual

This page has many more publications and resources that may be of use in facilitating CBPR.