A large body of basic research on memory, decision-making, and neural systems has accumulated with major implications for improving prevention effects through new strategies. One of the most promising avenues suggests ways to turn new preventive action plans into long-lasting habits. This can be accomplished by harnessing multiple processes, known to engage divergent neural systems, in ways that: a) consolidate action plans in memory at multiple levels;b) thoroughly link these plans to the situations that precede risk behaviors;and c) ensure action plans readily come to mind. The action plans then become highly accessible -- more spontaneously activated by situational cues. Although mere formation of action plans can be powerful in some behaviors and populations, memory consolidation of cue-linked action plans and specific forms of memory practice have a strong potential for long term effects on complex behaviors in at-risk populations. The present project applies, for the first time, this promising general strategy from basic research to the promotion o behaviors that reduce the risk of HIV [and hepatitis (HBV/HCV)] transmission: condom use and [testing of HIV/HBV/HCV]. These preventive behaviors are addressed in a population of adult drug offenders enrolled in "drug diversion" (educational) programs in lieu of incarceration. This growing population of mostly non-injection drug users is relatively easy to engage in preventive efforts on sexual risk and testing yet is documented at-risk for these infections. Indeed, they constitute one of the most readily available at-risk populations suitable for these preventive efforts, though evidence-based prevention programs have not yet been developed and evaluated for them. Preliminary studies reveal that specific strategies focusing on new preventive action plans, linkage of plans to risk situations, and consolidation in memory are promising in this population: a) participants are amenable to the strategies and actively engage in them;and b) the strategies show significant effects on formation and memory accessibility of action plans. The proposed study experimentally evaluates short-term prospective effects of action plan formation, memory consolidation, and memory practice on preventive behaviors (condom use and testing) and underlying basic processes. It is hypothesized that memory consolidation and practice will show superior effects on preventive behavior over effects of creating action plans alone or "standard care" health education. The study is conducted with drug diversion participants in existing drug education facilities. Thus, the intervention components can later be readily disseminated, since they are already tailored to the population and field setting. The investigators have repeatedly shown that carefully tailored basic research protocols are acceptable, feasible, and effective in this context. Community programs, such as drug diversion, are in urgent need of evidence-based, powerful interventions on [HIV/HBV/HCV] risk prevention. This project will experimentally evaluate theoretically sound, practical interventions with strong potential for improving public health.
This research will evaluate interventions designed to help at-risk drug users form and consolidate effective action plans for reducing HIV risk in themselves and others. These interventions are highly relevant to public health because they are tailored to a setting and population that is in urgent need of evidence based programs to reduce the risk of HIV/AIDS transmission.