This revised application is in response to the Mentored Patient-Oriented Research Career Development Award (K-23) and requests 4 years of support for formal coursework, hands-on training experiences, and research to improve HIV-risk reduction interventions targeting HIV-positive injection drug users (IDUs). Despite decades of HIV prevention campaigns targeting high-risk populations, including IDUs, and a rapidly expanding research literature on HIV-risk reduction, over 40,000 new HIV infections are reported yearly in the United States. A growing minority of high risk IDUs, including those who are HIV-positive, jeopardize their own health as well as the health of others via continued health-risk behaviors in three interrelated and modifiable ways including drug-related risks, sex-related risks, and non-adherence or sub-optimal adherence to HIV medication regimens. The behavioral factors perpetuating this epidemic are complex and dynamic. Some IDUs may demonstrate consistent risk behavior """"""""across the board"""""""" whereas others may only engage in certain types of risk behaviors while still others may increase risk behaviors in one or more areas in response to improvements in other risk areas (e.g., increasing sex- and/or drug-risk behaviors in response to learning that their viral load has become undetectable). Therefore, there is an urgent need to identify and understand the key components and dynamics that comprise more effective HIV-risk reduction interventions in order to create an intervention with greater potential to impact HIV-risk among HIV-positive IDUs. The primary goal of the proposed research is to reduce the transmission and spread of HIV/AIDS through risk behaviors of HIV-positive IDUs. This goal will be addressed through three specific aims: (1) To conduct a quantitative synthesis (meta-analysis) of the HIV risk reduction literature focused on IDUs to help specify the key components to consider in creating an optimized risk reduction intervention for HIV-positive IDUs, (2) To conduct elicitation research with HIV-positive IDUs and treatment providers to complement findings from the quantitative synthesis, and based on the above findings, (3) To design and pilot test a theory-driven, ecologically valid (community friendly), risk reduction intervention to significantly reduce HIV-risk behaviors among HIV-positive IDUs.
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