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Target Population’s Sources of Health Information
“Lots of people live in closed environments, especially if they’re hustling or selling drugs, but
other people too, they don’t know about services.  Even if it’s only a few miles away, or even a few
blocks away, they know nothing but their little corner or whatever, nothing outside of that,” comments a
resident of a Bay Area neighborhood with a high incidence of sex trade and drug use. Academic
research also suggests that “drug users and those involved in the sex industry often engage in activities
and lifestyles that place them outside the reach of more mainstream information channels.”
Anecdotal evidence reported by HAP outreach workers suggests that members of the target
population receive most of their information from television or word of mouth.  Frequently, the television
is located in the common room/lobby of their apartment building or hotel, and by default the program is
a talk show.  While such shows often cover health-related topics, including HIV/AIDS, the information
is generally partial and sometimes incorrect.  As part of outreach to a similar population in San
Francisco, HAP gave a test with basic questions about HIV/AIDS to 300 IDUs, sex workers and their
partners.  After an HIV education session, they scored an average of 18% higher on a post-test
compared to a pre-test.
While word-of-mouth can spread pernicious rumors among the target community (in the early
1990s, it was widely rumored that HIV tests were being performed with infected needles
), it is also a
strength.  In the past, HAP clients have requested information on health issues in order to educate
themselves as peer counselors.  A HAP outreach worker observed that, “Some people on the street
take pride in being the person who knows the answers.” 
Effectiveness of Referrals
In performing outreach for HIV mobile testing, HAP staff have concluded that standard
methods of referrals are ineffective with the target population.  As part of a prior project, HAP clients
who tested positive for STDs or had other health needs were given referral cards to present at the
appropriate agency.  Of approximately 500 cards issued, fewer than 10% were presented. 
A major obstacle to referrals is lack of client access to telephones.  Few have private lines in
their homes.  At best, they share a common phone with other residents of their hotel/apartment floor,
providing little privacy for calls related to personal issues.  The streets where outreach workers typically
Harder+Company p. 23.
Conversation with HAP outreach worker, January 14, 1998.
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