HIV and other sexually transmitted infection (STI) rates continue to rise disproportionately among African-Americans, and particularly dramatically among rural populations. Stimulant use, especially cocaine use, among rural African-Americans is also increasing, and is related to multiple risk behaviors for HIV/STI, including sex with multiple partners, exchanging sex for drugs and other commodities, and inconsistent condom use. Despite these documented risk patterns, and the increasing disparities in HIV/STI incidence, few theory-based interventions have been specifically designed and tested for rural African-American populations with high-risk behavioral patterns. The primary aims of this project are to adapt an existing risk reduction program to the needs of rural African-American cocaine users, to test the adapted intervention's efficacy via a behavioral clinical trial, and to answer outstanding questions regarding intraclass correlation and sampling methodologies in the sexual risk reduction literature. The project team will conduct a longitudinal intervention study with stratified group randomization, so that participants receive the sexual risk intervention or an active control intervention condition in groups. Each intervention condition is equivalent in terms of contact time and in terms of number and type of contacts (each participant receives two group sessions, two individual sessions, two community-building sessions, and two follow-up """"""""booster"""""""" sessions over four months). Respondent-driven sampling will be used to recruit and enroll 280 participants across two rural, predominantly African-American counties in the Arkansas Delta region to one of the two intervention conditions. The primary outcome variables will include condom use skills, sexual negotiation skills, and self-reported risk behaviors. Additional measures, including self-efficacy for decreased sexual risk, perceived peer norms for sexual risk, perceived benefits and barriers of sexual risk reduction, social support and social trust, mental health status, partner violence, and substance use, will also be collected to assess their theory-based mediating and moderating influences on the sexual risk skills and behaviors. Assessments will be conducted prior to the intervention, immediately post-intervention, and at 6- and 12-month follow-ups. This project brings together a strong, experienced investigative team which has an established, trusting relationship with the community that will be involved in the study. ? ?
The project not only will provide critically-needed information about the efficacy of tailored behavioral interventions among rural African-Americans at high risk for HIV/STIs, but also will allow the study team to investigate important methodological questions about the use of respondent- driven sampling approaches in rural settings and about intraclass correlation coefficients for sexual risk measures in tight-knit rural communities. This research can thus make important contributions that address racial disparities in HIV/STIs, provide approaches for slowing the rapid growth of the epidemics in rural areas, and inform methodological innovations of importance to sexual risk reduction science. ? ? ?
