Incarcerated women are at increased risk for contracting HIV. A unique constellation of factors contribute to this increased risk including histories of promiscuity, prostitution, exchange of sex for drugs, and numerous sexually transmitted diseases. More than 84,000 women are currently in state and federal prisons, and their numbers are increasing. Short sentences and recidivism to prison is common; therefore, movement between prison and home community is frequent. Incarcerated women face a disproportionate risk for contracting HIV upon their release and may in turn become reservoirs of infection for others. The proposed study will test a primary prevention Women-Centered Risk Reduction Intervention (WCRRI) for incarcerated women designed to prevent HIV infection through reducing sexual risk behaviors and enhancing sexual protective practices upon release from prison. The framework for this study--HIV Risk Reduction Framework (HR.)--is the AIDS Risk Reduction Model adjusted for delivery within a prison setting and after release from prison and modified by factors and experiences (depression, violence, relationships, substance abuse) common to women prisoners that are believed to influence their HIV risk reduction efforts. The expected outcomes of the proposed intervention are enactment and maintenance of sexual protective practices following release from prison. A three-group randomized control design will be used to compare women who receive the WCRRI with those who receive either the NIDA Standard Intervention for HIV Prevention or the Staying Fit and Healthy placebo. The WCRRI group will receive 8 group sessions designed to reduce HIV risks, follow-up group and individual sessions before release, and telephone booster sessions at 2, 6 and 10 weeks after release from prison. The NIDA intervention group will receive a two-session educational and counseling intervention. The Stay Fit placebo group will receive the same number of group and individual sessions as the WCRRI group. All women will be re-interviewed 1 week after the in-prison intervention, and at 1, 3, 6 and 9 months post-release. Multivariate repeated measures models would be used to test for intervention effects in behavioral labeling, commitment to change, enactment skills, and sexual protective practices. If successful, the proposed intervention will serve as a model for HIV prevention efforts in women's prisons and we will have the opportunity to translate it for broader application. ? ? ?
