Skid Row Area Research Articles

Exploratory assessment: Nurse-led community health worker delivered HCV intervention for people experiencing homelessness.

Getting and maintaining Hepatitis C Virus (HCV) cure is challenging among people experiencing homelessness (PEH) as a result of critical social determinants of health such as unstable housing, mental health disorders, and drug and alcohol use. The purpose of this exploratory pilot study was to compare a registered nurse/community health worker (RN/CHW)-led HCV intervention tailored for PEH, "I am HCV Free," with a clinic-based standard of care (cbSOC) for treating HCV. Efficacy was measured by sustained virological response at 12 weeks after stopping antivirals (SVR12), and improvement in mental health, drug and alcohol use, and access to healthcare. An exploratory randomized controlled trial design was used to assign PEH recruited from partner sites in the Skid Row Area of Los Angeles, California, to the RN/CHW or cbSOC programs. All received direct-acting antivirals. The RN/CHW group received directly observed therapy in community-based settings, incentives for taking HCV medications, and wrap-around services, including connection to additional healthcare services, housing support, and referral to other community services. For all PEH, drug and alcohol use and mental health symptoms were measured at month 2 or 3 and 5 or 6 follow-up, depending on HCV medication type, while SVR12 was measured at month 5 or 6 follow-up. Among PEH in the RN/CHW group, 75% (3 of 4) completed SVR12 and all three attained undetectable viral load. This was compared with 66.7% (n = 4 of 6) of the cbSOC group who completed SVR12; all four attained undetectable viral load. The RN/CHW group, as compared to the cbSOC, also showed greater improvements in mental health, and significant improvement in drug use, and access to healthcare services. While this study shows significant improvements in drug use and health service access among the RN/-CHW group, the sample size of the study limits the validity and generalizability of the results. Further studies using larger sample sizes are necessitated.

256 Safety and Efficacy of a Sobriety Emergency Response Unit in an Urban Emergency Medical Services System

Approximately 1% of all emergency department (ED) visits in the United States involve uncomplicated alcohol-related complaints, and these patients may undergo unnecessary testing while occupying limited ED resources. Most of these patients arrive by emergency medical services (EMS) ambulance. This is a preliminary evaluation of the safety and efficacy of a new Sobriety Emergency Response (SOBER) Unit, which is a unique EMS resource staffed with a firefighter/paramedic, a nurse practitioner and caseworker, whose mission is to medically clear publicly inebriated patients and transport them to a sobering center, where they can be connected to appropriate mental health and social services, instead of transport to an ED. The study was conducted in the City of Los Angeles, which has a population of approximately 4.1 million covering 471 square miles. Los Angeles Fire Department (LAFD) provides all 911 EMS responses via a tiered, fire-based basic life support (BLS) and advanced life support (ALS) system. Data were collected prospectively for the first 6 months of implementation of the SOBER Unit, from November 2017 to May 2018. Inclusion criteria included age between 18-65 years old, suspected alcohol intoxication, no evidence of head injury and non-combative patients. Exclusion criteria included any loss of consciousness, Glasgow Coma Scale < 14, any anticoagulant use, pulse rate > 120 or < 50 beats per minute, blood glucose > 250 or < 60 mg/dL, or any evidence of trauma above the clavicles. Descriptive statistics were captured. The SOBER Unit was operational Tuesday through Friday from 1000-2000 hours around the Skid Row area of downtown Los Angeles. The unit was activated via request by on-scene LAFD units or responding to calls at their discretion. All secondary transports from the sobering center to an ED were captured. There were 419 patients evaluated by the SOBER Unit, of whom 374 (89.3%) were transported. Of the 374 transports, 363 (97%) were taken directly to the sobering center in lieu of transport to an ED. The mean age was 46.6 years (IQR 17, median 48) and 337 (85%) were male. Additionally, 6 (2%) were medically cleared and directly transported to a mental health urgent care center. Of those treated, common comorbidities were substance abuse (51%), hypertension (14%) and psychiatric illness (10%). There were 393 total transports for 298 unique patients. Six patients had 5 or more transports, of which 1 was placed in long term substance abuse housing through the sobering center and had no further 911 or SOBER Unit contacts. There were 10 secondary transports from the sobering center to an ED: 8 were transported via non-emergency van and 2 were transported via 911 ambulance (1 for seizure activity and the other because his wheelchair could not be accommodated in the non-emergency van). In the study period, all patients who required secondary transport were either treated and released from the ED or discharged home within 72 hours, with no significant adverse effects. Preliminary data suggests that a mobile SOBER unit is a safe and efficacious means of medically clearing public inebriates and transporting them to a supportive, non-ED setting. Further research is needed to determine its long-term impact on recidivism and cost-effectiveness.

Location, Location, Location: Perceptions of Safety and Security Among Formerly Homeless Persons Transitioned to Permanent Supportive Housing

AbstractObjective: Low perceived safety and security might have adverse health consequences, especially for chronically homeless individuals who are at high risk of victimization on the street. Permanent supportive housing (PSH) is an effective strategy to address chronic homelessness and improve residents’ health and well-being. However, it is unclear how formerly homeless individuals’ perceptions of safety and security reflect the objective neighborhood environment in which the PSH is located. This article presents a study of the perceived safety and security of formerly homeless individuals transitioned to PSH in and around Skid Row. Method: This mixed-method study examines the perceptions of safety and security of 24 PSH residents living in the Skid Row area of Los Angeles. Subsequent block-based neighborhood observations were conducted informed by these qualitative findings. Results: Although participants felt safer relative to when they were homeless, residents living within Skid Row felt less safe ...

Understanding Consistent Condom Use Among Homeless Men Who Have Sex with Women and Engage in Multiple Sexual Partnerships: A Path Analysis.

Consistent condom use is the main strategy aimed at preventing individuals from acquiring HIV through sexual intercourse. The mechanism of consistent condom use among a high-risk homeless subpopulation-homeless men who have sex with women and also engage in multiple sexual partnerships-remains unclear. This study identified 182 homeless men who engaged in multiple sexual partnerships from a representative sample of homeless men, who self-identified as heterosexual, using meal line services in Downtown Los Angeles' Skid Row area. Information such as participants' condom use psychosocial correlates, sexual risk behaviors, and social network characteristics were collected. Results suggested that condom efficacy is a potential intervening mechanism through which condom attitudes (β=-0.199; p=0.005) and depression (β=-0.156; p=0.029) are associated with an individual's consistent condom use. Having more network members with whom participants talked about HIV prevention (β=0.051; p=0.006) was also found to be associated with an individual's consistent condom use. HIV prevention programs should focus on increasing their condom efficacy to help reduce HIV risks among this vulnerable homeless subpopulation.

Ella Howard. Homeless: Poverty and Place in Urban America.

In recent decades, scholars such as Joel Blau, Leonard Feldman, Kim Hopper, Christopher Jencks, Kenneth Kusmer, Peter Rossi, Neil Smith, and Alex Vitale have published fascinating studies about homelessness in the United States. These works contradict the “conventional wisdom” that no one cares about poor people in the United States and that the study of the homeless is a thankless undertaking about a marginalized population that seldom matters. Ella Howard's Homeless: Poverty and Place in Urban America is an excellent addition to these studies of homelessness, providing a much-needed historical perspective on the nation's largest skid row area, the Bowery in New York City. Howard's research is grounded in archival sources from institutions such as the New York State Archives, the Municipal Archives of the City of New York, the Columbia University Archives, the New York Public Library, and the Salvation Army National Archives and Research Center. In the process, Howard shows how a series of institutions during the twentieth century took an interest in the homeless, only to provide half-hearted assistance.

Masculinity and HIV risk among homeless men in Los Angeles.

HIV continues to be a serious public health problem for men who have sex with women (MSW), especially homeless MSW. Although consideration of gender has improved HIV prevention interventions, most of the research and intervention development has targeted how women's HIV risk is affected by gender roles. The effect of gender roles on MSW has received relatively little attention. Previous studies have shown mixed results when investigating the association between internalization of masculine gender roles and HIV risk. These studies use a variety of scales that measure individual internalization of different aspects of masculinity. However, this ignores the dynamic and culturally constructed nature of gender roles. The current study uses cultural consensus analysis (CCA) to test for the existence of culturally agreed upon masculinity and gender role beliefs among homeless MSW in Los Angeles, as well as the relationship between these beliefs and HIV-related behaviors and attitudes. Interviews included 30 qualitative and 305 structured interviews with homeless MSW in Los Angeles's Skid Row area. Analysis identified culturally relevant aspects of masculinity not represented by existing masculinity scales, primarily related to barriers to relationships with women. Behaviors, attitudes, and knowledge related to HIV were significantly associated with men's level of agreement with the group about masculinity. The findings are discussed in light of implications for MSW HIV intervention development.

Engaging Homeless Youth in Community-Based Participatory Research

Growing evidence highlights the benefits to youth of involvement in community-based participatory research. Less attention has been paid, however, to the contributions youth can make to helping change health-promoting policy through such work. We describe a multi-method case study of a policy-focused community-based participatory research project in the Skid Row area of downtown Los Angeles, California, where a small group of homeless youth worked with adult mentors to develop and conduct a survey of 96 homeless youth and used the findings to help secure health-promoting policy change. We review the partnership's work at each stage of the policy-making process; its successes in changing policy regarding recreation, juvenile justice, and education; and the challenges encountered, especially with policy enforcement. We share lessons learned, including the importance of strong adult mentors and of policy environments conducive to sustainable, health-promoting change for marginalized youth.

Transitioning from Homelessness: A “Fresh-Start” Event

Permanent supportive housing (PSH) has been recognized as central to the goal of ending chronic homelessness. This qualitative study considers the positive and negative expectations of 31 men and women in the Skid Row area of Los Angeles who are beginning the transition from homelessness to PSH through a Housing First approach. This study uses in-depth, qualitative interviews and an inductive approach informed by sensitizing concepts derived from the literature and thematic analysis of case summaries, interview transcripts, and interviewer feedback and observation. Three themes emerged from the data: (a) nowhere to go but up, (b) some things stay the same, and (c) neighborhood matters. These findings indicate that PSH is regarded as a fresh start and universally positive experience, and that the role of neighborhood highlights a tension in the pursuit of recovery from homeless between removing people from their neighborhoods versus keeping them close to their previous and familiar environments. Implications for social work practice include that maximizing a successful transition will require understanding and managing people’s expectations and reality.

Unprotected Sex Among Heterosexually Active Homeless Men: Results from a Multi-level Dyadic Analysis

HIV is a serious public health problem for homeless populations. Homeless men who have sex with women have received less attention in the HIV risk literature than other homeless populations. This research uses multi-level modeling to investigate the context of unprotected sex among heterosexually active homeless men in the Skid Row area of Los Angeles. Based on interviews with 305 randomly selected men who discussed 665 of their recent female sexual relationships, this project investigates the correlates of unprotected sex during the past 6 months at the partnership, individual, and social network levels. Several different measures of relationship closeness and lack of communication about HIV/condoms were associated with unprotected sex. Controlling for relationship factors, men's negative attitudes towards condoms, mental health, and higher number of male sex partners also were associated with having unprotected sex with female partners. We discuss the implications of these findings for health interventions.

Screening, brief intervention, and referral to treatment for risky stimulant use in a Skid Row community health center

The University of California at Los Angeles Quit Using Drugs Intervention Trial (QUIT) aims to conduct a randomized controlled trial of a primary-care based very brief intervention protocol for reducing risky stimulant use and drug-related harm in low-income, racially diverse primary care patients attending safety-net clinics in the east central Skid Row area of Los Angeles. The QUIT trial emphasizes screening, very brief clinician advice (2-3 minutes), and two telephone drug-use health education sessions versus usual-care in the control group (240 patients per condition). Between February 18 and April 28, 2011, pre-visit screening of adults in the waiting room was conducted using a touch-screen Tablet PC. “At risk” drug use was defined as casual, frequent, or binge use without the physiological or psychological manifestations of dependence (a score of 4 to 26 on the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). A total of 920 adult patients were approached: 89% were 40+ years old; 68% were male; 62% were black, 21% were Latino, and 17% were white. Of patients approached, 706 were excluded due to pregnancy, because it was a nonprimary care visit, or because they refused to participate. Among the 214 who completed the ASSIST, substance use scores were none or low risk in 11% of participants, moderate risk in 42%, and dependence-level in 47%. The number of participants in each score range by substance were, respectively, tobacco 55, 101, and 58; alcohol 62, 98, and 54; cannabis 94, 77, and 43; cocaine 89, 74, and 51; methamphetamine/amphetamine type stimulants 145, 45, and 23; inhalants 185, 20, and 9; sedatives 143, 45, and 26; hallucinogens 174, 30, and 10; and opioids 130, 54, and 30. Participants who were older than 50 years were more likely to use tobacco, alcohol, cannabis, and cocaine; younger patients were more likely to use amphetamines, inhalants, sedatives, hallucinogens, and opioids. Twenty-seven patients (3% of those approached) met study criteria of past three-month risky stimulant use. Seventy percent were homeless, and 30% were marginally housed. In Skid Row, only 3% of patients qualified for risky stimulant use intervention.

Prevalence, Distribution, and Correlates of Hepatitis C Virus Infection among Homeless Adults in Los Angeles

We documented the prevalence, distribution, and correlates of hepatitis C virus (HCV) infection among urban homeless adults. We sampled a community-based probability sample of 534 homeless adults from 41 shelters and meal programs in the Skid Row area of downtown Los Angeles, California. Participants were interviewed and tested for HCV, hepatitis B, and HIV. Outcomes included prevalence, distribution, and correlates of HCV infection; awareness of HCV positivity; and HCV counseling and treatment history. Overall, 26.7% of the sample tested HCV-positive and 4.0% tested HIV-positive. In logistic regression analysis, independent predictors of HCV infection for the total sample included older age, less education, prison history, and single- and multiple-drug injection. Among lifetime drug injectors, independent predictors of HCV infection included older age, prison history, and no history of intranasal cocaine use. Among reported non-injectors, predictors of HCV infection included older age, less education, use of non-injection drugs, and three or more tattoos. Sexual behaviors and snorting or smoking drugs had no independent relationship with HCV infection. Among HCV-infected adults, nearly half (46.1%) were unaware of their infection. Despite the high prevalence of HCV infection, nearly half of the cases were hidden and few had ever received any HCV-related treatment. While injection drug use was the strongest independent predictor, patterns of injection drug use, non-injection drug use, prison stays, and multiple tattoos were also independent predictors of HCV. Findings suggest that urgent interventions are needed to screen, counsel, and treat urban homeless adults for HCV infection.

HIV Risk Behavior and Access to Services: What Predicts HIV Testing among Heterosexually Active Homeless Men?

HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV testing behavior of homeless men. This study examined the association between individual (HIV risk) and structural (service access) factors and past year HIV testing. Participants were a representative sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles. Logistic regression examined the association between past year HIV testing and demographic characteristics, HIV risk behavior, and access to other services in the Skid Row area in the past 30 days. Despite high rates of past year HIV testing, study participants also reported high rates of HIV risk behavior, suggesting there is still significant unmet need for HIV prevention among homeless men. Having recently used medical/dental services in the Skid Row area (OR: 1.91; CI: 1.09, 3.35), and being a military veteran (OR: 2.10; CI: 1.01-4.37) were significantly associated with HIV testing service utilization. HIV testing was not associated with HIV risk behavior, but rather with access to services and veteran status, the latter of which prior research has linked to increased service access. We suggest that programs encouraging general medical service access may be important for disseminating HIV testing services to this high-risk, vulnerable population.

Understanding Heterosexual Condom Use among Homeless Men

This study uses an event-based approach to examine individual, relationship, and contextual correlates of heterosexual condom use among homeless men. Structured interviews were conducted with a predominantly African American sample of 305 men recruited from meal lines in the Skid Row area of Los Angeles. Men reported on their most recent heterosexual event involving vaginal or anal intercourse. Adjusting for demographic characteristics only, condom use was more likely when men had higher condom use self-efficacy, greater HIV knowledge, or talked to their partner about condoms prior to sex. Condom use was less likely when men held more negative attitudes towards condoms, the partner was considered to be a primary/serious partner, hard drug use preceded sex, or sex occurred in a public setting. Condom attitudes, self-efficacy, partner type, and communication were the strongest predictors of condom use in a multivariate model that included all of the above-mentioned factors. Associations of unprotected sex with hard drug use prior to sex and having sex in public settings could be accounted for by lower condom self-efficacy and/or less positive condom attitudes among men having sex under these conditions. Results suggest that it may be promising to adapt existing, evidence-based IMB interventions for delivery in non-traditional settings that are frequented by men experiencing homelessness to achieve HIV risk reduction and thus reduce a significant point of disparity for the largely African American population of homeless men.

Behavioral health and social normative influence: correlates of concurrent sexual partnering among heterosexually-active homeless men.

Sexual concurrency poses significant HIV/STI transmission risk. The correlates of concurrency have not been examined among homeless men. A representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row area of Los Angeles reported on their mental health, substance use, and social network characteristics. Nearly 40% of men reported concurrency with one of their four most recent sex partners. Results indicated that HIV seropositivity (OR=4.39, CI: 1.10, 17.46; P=0.04), PTSD (OR=2.29, CI: 1.05, 5.01; P=0.04), hard drug use (OR=2.45, CI: 1.07, 5.58; P=0.03), and the perception that network alters engage in risky sex (OR=3.72, CI: 1.49, 9.30; P=0.01) were associated with increased odds of concurrency. Programs aimed at reducing HIV/STI transmission in this vulnerable population must take into account the roles that behavioral health and social networks may play in sexual concurrency.

Correlates of Adult Assault among Homeless Women

The purpose of this study was to assess predictors of sexual and physical assault among homeless women. A multivariate, correlation design was utilized to identify independent correlates of adult physical and sexual assault. The sample consisted of 202 homeless women residing in shelters or living on the street in the Skid Row area of Los Angeles. Respondents reporting a history of child sexual abuse were almost four times more likely to report being sexually assaulted as adults and were almost two and one third times more likely to report being physically assaulted as adults. A range of factors increase homeless women's risk of adult physical and sexual victimization, including child sexual abuse, substance use, lifetime sex trade activity, and previous incarceration. It is important for homeless service providers to develop an individual risk profile for homeless women and to intervene in order to decrease their risk of re-victimization.

‘Weak‐Center’ Gentrification and the Contradictions of Containment: Deconcentrating Poverty in Downtown Los Angeles

This case study of recent efforts to deconcentrate poverty within the Skid Row area of Los Angeles examines processes of "weak-center" gentrification as it applies to a "service dependent ghetto," thus filling two key gaps in prior scholarship. We document the collaboration between the government, business and development interests, and certain non-profit agencies in this process and identify two key mechanisms of poverty deconcentration: housing/service displacement and the criminalization of low income residents. Following Harvey, we argue that these efforts are driven by pressures to find a "spatial fix" for capital accumulation through Downtown redevelopment. This process has been hotly contested, however, illustrating the strength of counter-pressures to gentrification/poverty deconcentration within "weak-center" urban areas.

Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA

Background Fatal opioid overdose is a significant cause of mortality among injection drug users (IDUs). Methods We evaluated an overdose prevention and response training programme for IDUs run by a community-based organisation in Los Angeles, CA. During a 1-h training session participants learned skills to prevent, recognise, and respond to opioid overdoses, including: calling for emergency services, performing rescue breathing, and administering an intramuscular injection of naloxone (an opioid antagonist). Between September 2006 and January 2008, 93 IDUs were trained. Of those, 66 (71%) enrolled in the evaluation study and 47 participants (71%) completed an interview at baseline and 3-month follow-up. Results Twenty-one percent of participants were female, 42% were white, 29% African American, and 18% Latino. Most were homeless or lived in temporary accommodation (73%). We found significant increases in knowledge about overdose, in particular about the use of naloxone. Twenty-two participants responded to 35 overdoses during the follow-up period. Twenty-six overdose victims recovered, four died, and the outcome of five cases was unknown. Response techniques included: staying with the victim (85%), administering naloxone (80%), providing rescue breathing (66%), and calling emergency services (60%). The average number of appropriate response techniques used by participants increased significantly from baseline to follow-up ( p < 0.05). Half (53%) of programme participants reported decreased drug use at follow-up. Conclusion Overdose prevention and response training programmes may be associated with improved overdose response behaviour, with few adverse consequences and some unforeseen benefits, such as reductions in personal drug use.

Effects of a nurse-managed program on hepatitis A and B vaccine completion among homeless adults.

Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. A randomized, three-group, prospective, quasi-experimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI). Sixty-eight percent of the NCMIT participants completed the three-series vaccine at 6 months, compared with 61% of SIT participants and 54% of SI participants. NCMIT participants had almost 2 times greater odds of completing vaccination than those of participants in the SI program. Completers were more likely to be older, to be female, to report fair or poor health, and not to have participated in a self-help drug treatment program. Newly homeless White adults were significantly less likely than were African Americans to complete the vaccine series. The use of vaccination programs incorporating nurse case management and tracking is critical in supporting adherence to completion of a 6-month HAV/HBV vaccine. The finding that White homeless persons were the least likely to complete the vaccine series suggests that programs tailored to address their unique cultural issues are needed.

Tuberculosis skin testing among homeless adults.

To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB. Cross-sectional study. Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles. A representative sample of 260 homeless adults. Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%:40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age. Homeless adults living in congested inner-city areas are at high risk of both latent and active TB. Endemic risk factors and limited access to medical care support the need for aggressive treatment of active TB cases and innovative programs to ensure completion of prophylactic regimens by homeless individuals with latent infection.

Reliability, Validity, and Composition of a Subset of the Centers for Disease Control and Prevention Acquired Immunodeficiency Syndrome Knowledge Questionnaire in a Sample of Homeless and Impoverished Adults

Measures of acquired immunodeficiency syndrome (AIDS)-related knowledge that have good psychometric properties are needed to evaluate the impact of educational interventions, particularly among impoverished populations. Few measures that satisfy these requirements are available. The authors describe the psychometric characteristics and composition of a subset of 21 AIDS knowledge items from the questionnaire used by the National Center for Health Statistics. The study was conducted with a convenience sample of women and their significant others or close friends in nine homeless shelters and 11 residential drug recovery programs in the skid row area of Los Angeles from 1991 to 1993. Trained nurses and outreach workers collected data from 486 predominately African-American adults before delivery of well-established, culturally sensitive AIDS educational intervention. A subset of 334 participants were re-interviewed 6 months later. A total scale score was calculated from a one-factor solution, and two subscale scores were formed based on a two-factor solution. One subscale was composed of primarily cognitive items, whereas the second subscale contained mainly transmission-related items. The internal consistency reliability of the overall scale was 0.89; the two subscales had alphas of 0.80 and 0.92. The measures have face validity, and support for convergent validity was found. Further, even though AIDS knowledge in the sample was relatively high, all three measures showed marked improvement in the subsample of respondents who were re-interviewed after receiving AIDS-related educational information. These measures show promise for assessing AIDS knowledge and the efficacy of AIDS education programs in vulnerable populations. The findings reported here, however, are preliminary. Test-retest reliability needs to be examined, and additional studies are needed with samples that are more culturally diverse and include socially isolated individuals.