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Such interventions have the potential to affect multiple social levels of risk and change, including at the individual, network, and community levels, and reflect social ecological principles of interaction across social levels over time. The iterative and feedback dynamic generated by this multi\u2010level effect increases the likelihood for sustained health improvement initiated by those trained to deliver the peer intervention. The Risk Avoidance Partnership (RAP), conducted with heroin and cocaine\/crack users in Hartford, Connecticut, exemplified this intervention design and illustrated the multi\u2010level effect on drug users' risk and harm reduction at the individual level, the social network level, and the larger community level. Implications of the RAP program for designing effective prevention programs and for analyzing long\u2010term change to reduce HIV transmission among high\u2010risk groups are discussed from this ecological and multi\u2010level intervention perspective.<\/jats:p>","DOI":"10.1007\/s10464-009-9234-z","type":"journal-article","created":{"date-parts":[[2009,3,26]],"date-time":"2009-03-26T17:17:28Z","timestamp":1238087848000},"page":"330-344","source":"Crossref","is-referenced-by-count":52,"title":["Changing Drug Users' Risk Environments: Peer Health Advocates as Multi\u2010level Community Change Agents"],"prefix":"10.1002","volume":"43","author":[{"given":"Margaret R.","family":"Weeks","sequence":"first","affiliation":[{"name":"Institute for Community Research 2 Hartford Square West, Suite 100 06106 Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Convey","sequence":"additional","affiliation":[{"name":"Institute for Community Research 2 Hartford Square West, Suite 100 06106 Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Dickson-Gomez","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin 8701 Watertown Plank Rd 53226-0509 Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianghong","family":"Li","sequence":"additional","affiliation":[{"name":"Institute for Community Research 2 Hartford Square West, Suite 100 06106 Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Radda","sequence":"additional","affiliation":[{"name":"Institute for Community Research 2 Hartford Square West, Suite 100 06106 Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Martinez","sequence":"additional","affiliation":[{"name":"Institute for Community Research 2 Hartford Square West, Suite 100 06106 Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Robles","sequence":"additional","affiliation":[{"name":"Institute for Community Research 2 Hartford Square West, Suite 100 06106 Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,3,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.14.6.526"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.84.2.191"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4899-1193-3_3"},{"key":"e_1_2_6_5_1","first-page":"1","article-title":"Keeping the S-curve in mind-sustainability","volume":"3","author":"Barnett T","year":"1997","journal-title":"AIDS\/STD Health Promotion Exchange"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200006001-00003"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-005-9007-4"},{"issue":"1","key":"e_1_2_6_8_1","first-page":"42","article-title":"Harnessing peer networks as an instrument for AIDS prevention: Results from a peer-driven intervention","volume":"113","author":"Broadhead RS","year":"1998","journal-title":"Public Health Reports"},{"key":"e_1_2_6_9_1","doi-asserted-by":"crossref","DOI":"10.4159\/9780674028845","volume-title":"The ecology of human development","author":"Bronfenbrenner U","year":"1979"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2190\/AKCP-L5A4-MXXQ-DW9K"},{"key":"e_1_2_6_11_1","unstructured":"Convey M. 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