Social Networks, Drug Injectors' Lives, and HIV/AIDS

In Bushwick, a Brooklyn neighborhood of abandoned buildings and underemployment, Samuel R. Friedman, Richard Curtis, Alan Neaigus, Benny Jose, and Don C. Des Jarlais found and cared for a community hard hit by an AIDS epidemic fueled by heroin and crack cocaine addiction. It is rare to see the words "love" and "soul searching" in a book about rigorously conducted scientific research. Such words reflect the researchers' feelings toward the community they studied and what they hope to evoke in readers about the very human lives of people who inject drugs.

Friedman and colleagues are pioneers in network analysis. They show convincingly how the structure of social relationships can affect the risk of HIV infection. In the case of drug injectors, ethnographic approaches are used to map and analyze condom use and receptive syringe sharing to identify predictors of risk behaviors at the level of the individual, the dyad, and the network.

This is new territory even for most researchers; clinicians, administrators, and policy makers will all find something useful in this book. The authors manage with compassion and clarity to guide the reader through epidemiology, theory, methodology, and harrowing first-person accounts of drug injectors' complex and sometimes risky interconnections, and they point the way to usable prevention strategies.

This book represents the culmination of a decade's work by consummate researcher-advocates who are not content to disseminate their findings in peer-reviewed scientific journals but who wish to build on research findings to improve the lives of the people they have studied. Pragmatism and the desire to produce change permeate all 13 chapters of this book. In chapter 2, entitled "Learning From Lives," drug injectors describe their drug use, their sex lives, and the economies that can link them as well as their HIV-related worries and practices. In the more technical chapters, such as "Network Concepts and Serosurvey Methods," the authors illustrate their terms by referring back to individuals whose voices and stories we heard in chapter 2. This narrative strategy is very effective and makes for memorable reading of abstract concepts.

Only rarely do the authors lose their balance—for example, when they cite failures of attention and action by "steely-eyed social workers." Blaming the helper is not particularly useful as critique or persuasion. Such moments give the reader close glimpses of the authors' frustration and sense of outrage at the social injustice and public-health imprudence of writing off a group of human beings through "localized repression and stigmatization."

Most of the observations contained in this book were made in the early 1990s. Although Friedman and colleagues are careful to place their work and what preceded it—previous research, drug policy, enforcement, and other issues—in historical context, little mention is made of changes in the AIDS epidemic, drug use practices, sexual behavior, and all the complex factors that affect them in Bushwick and elsewhere since that time. It is likely that drug injectors' lives have changed in important ways in the intervening years—for example, use of shooting galleries has declined—even if the social-network approaches to understanding these changes have not. Still, this book provides a vivid portrait of how drug injectors are living in the AIDS epidemic and of what remains to be accomplished.