Drug abuse-associated behavior continues to be a significant factor in the spread of HIV/AIDS in the United States - both directly and indirectly. The use of injection and non-injection illicit drugs, as well as alcohol, can increase HIV transmission risk through its impact on decision making and sexual risk taking. To address this issue, State of the Art, Inc. (SOTA) proposes the development of an interactive educational resource entitled """"""""HIV and Sober Intimate Behavior"""""""" (HSIB) for gay men in substance abuse treatment that addresses the intersection of HIV risk and substance use within the context of the recovery process. At the center of the HSIB package is a computer-based, interactive simulation program that allows audiences to not only learn important skills, but to practice them within a virtual environment. HSIB strives to provide skill-building information for re-engaging in intimate behavior and relationships within a sober context, in order to help those in recovery reduce their HIV risk and avoid relapse in the face of psychosocial challenges. To accomplish this long-term objective, HSIB materials aim to 1) increase knowledge around healthy intimate behavior and reducing HIV risk, 2) teach skills around healthy intimate behavior that will help those in recovery to navigate obstacles, to maintain sobriety, and to reduce HIV risk, and 3) provide an opportunity for men in recovery to practice these skills and build self-efficacy around them. In Phase II, HSIB materials will be produced based on research and prototype materials developed in Phase I, and qualitative and quantitative evaluations will be conducted. In-depth interviews with gay men in recovery and a focus group with substance abuse professionals will take place during the materials developmental stage in order to help ensure that HSIB materials match the values and needs of these audiences. Interviews and focus groups will be conducted by trained interviewers/moderators using standard qualitative research methods (Krueger, 1998), and cross-group comparisons will be made between treatment groups. A content review of materials by project advisors will supplement research and highlight any additional areas in need of revision. After revisions and production of the final HSIB materials, a quantitative evaluation will measure their effectiveness in educating gay men in recovery about maintaining sobriety and reducing their risk of HIV infection/transmission, as well as building their motivation, self-efficacy, and intent to engage in preventive health behaviors. [Using a randomized control trial design, gay men in recovery will be randomized to a study group and post-intervention questionnaires will be administered one week and one-month after exposure. A comparison of intervention and control group scores on four-point scale measures will determine if responses significantly migrate toward opinions expressed in the materials.]
The HIV/AIDS epidemic has had a dramatic effect on substance abuse treatment. HIV exposure has been directly linked to injection drugs through needle sharing, however non-injection drugs are also a factor as they impair judgment and elevate risk through unprotected sexual contact, a greater number of casual partners, partners of unknown serostatus, an exchange of sex for drugs, and other high-risk behaviors. As the importance of drug abuse treatment in reducing the spread of HIV is recognized, emphasis is being placed on getting substance abusers into treatment and preventing relapse into prior high-risk behaviors. HIV prevention efforts for those in recovery must address sexual transmission risks as well as risks associated with injection drugs. By promoting HIV prevention within the context of recovery, HSIB research and resources have the potential to help men initiate positive health behaviors that promote the maintenance of sobriety and the reduction of HIV risk;thereby reducing the prevalence of HIV transmission, relapse, and their associated costs.