The 4.5-year revised community-based field experiment proposed in this application is in response to a program announcement from the National Institute on Drug Abuse (NIDA) on """"""""Women's HIV Risk and Protective Behaviors"""""""" (PA-95-083). With the alarming increase in the number of women becoming infected with HIV, particularly African-American women, an urgency exists for more women-Focused interventions to assist women in reducing risky behaviors. Although several interventions have been demonstrated to reduce overall HIV and infectious disease risks, most have targeted those who inject drugs and share needles. Drug-using women in the Southeast, in contrast, are more likely to be crack users and low-frequency injectors-putting them primarily at risk from sexual transmission. We are proposing to use a randomized field experiment with 1,200 African-American women from two North Carolina counties to evaluate the effectiveness of three interventions: (a) a Woman-Focused intervention, (b) Standard-R, an intervention modeled on the existing NIDA standard HIV intervention, and (c) a Control group that receives only CDC HIV antibody testing and counseling. The Woman-Focused intervention is designed to address HIV risk through a personal, contextually relevant, and Acrocentric perspective. We hypothesize that by addressing issues of primary importance to African-American women, by demonstrating to them their individual risk, and by addressing specific concerns of their lives, our intervention will have a more substantial positive effect on the women's HIV/infectious disease risk behaviors than less specific interventions. We also propose to strengthen their social support and linkages to needed services, which will serve as protective factors. We expect that the women receiving this intervention will become more responsive to HIV/infectious disease prevention interventions, maintain safer behaviors, and begin to form their own social supports based on healthier behaviors and social reinforcement. We also propose strong linkages to drug treatment programs, particularly for welfare-eligible women who are faced with losing support due to welfare reform and women who trade sex for drugs, money, or other essentials. We further intend to estimate the relative cost of both the Woman-Focused intervention and the Standard-R intervention in comparison to the minimal Control group.
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