In 1988 the National Institute on Drug Abuse (NIDA) funded the Puerto Rico AIDS Prevention Project (PRAPP), one of 41 national AIDS demonstration research programs. These projects target out-of-treatment injecting drug users (IDUs), and attempt through community-based interventions to reduce high-risk behaviors associated with HIV transmission. From May 1989 through July 1990, outreachers working in PRAPP recruited 1702 out-of-treatment IDUs from four high drug-use areas in metropolitan San Juan. Outreachers encountered diverse recruitment and retention problems: 1) out-of-treatment IDUs are sometimes difficult to contact; 2) IDUs are recruited frequently in high-crime areas; 3) some IDUs feel uncomfortable being tested for HIV and revealing personal information on high-risk behaviors: 4) some IDUs do not wish to obtain HIV test results; and 5) it may be difficult to maintain subjects' participation over several months from time of initial contact to follow-up interview and HIV test. This paper describes recruitment and retention problems that arose in PRAPP, and the critical role of indigenous outreach workers in resolving these problems. Solutions devised by project personnel have broader application to the question of how to deliver health care services to hard-to-reach populations.

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