This is a revised proposal for the project, Peer Activism for Female Partners of Injection Drug Users. The combination of grave HIV epidemiology and severe environmental obstacles to HIV-safer sexual behavior change argues for an empowerment-driven approach to HIV prevention among female sexual partners (FSPs) of injection drug users. On the streets of the Lower East Side of Manhattan, 275 FSPs will be recruited into a randomized trial of HIV prevention peer activism training versus women's health education (serving as a non-specific psychological intervention comparison). The primary goals of the peer activist training are to increase HIV-safer sexual behavior and to maintain these increments at one-year post-intervention. Both storefront interventions will consist of two phases: 1) two-month intensive (i.e., weekly) intervention; and 2) 10-month maintenance (i.e., monthly) group in the form of activism supervision for the peer activism training and continued health education for the comparison. The peer activism training will impart proficiency in three maintenance-phase activist tasks: 1) individual HIV safer sexual role-modeling outreach discussions with 8-10 women in one's personal network; 2) HIV safer sex role-modeling outreach contacts with 10-12 (previously unknown) women in one's neighborhood; and 3) self-help group organization, planning, and implementation of one community HIV prevention event. The project will begin with a three-month formative evaluation phase in which ethnographic street observation, focus groups, and Community Advisory Board meetings will be used to tailor interventions and assessments to the needs, cultural norms, and life situations of FSPs. In both interventions, a repeated measures interview will be administered at four points: 1) baseline; 2) end of intensive intervention (i.e., two months later); 3) end of maintenance intervention (i.e., one year later); and 4) one-year post-intervention (i.e., two years later). Data analyses will assess the relative efficacy of peer activist training versus women's health education of the following empowerment theory-driven variables as mediators of hypothesized peer activist training intervention effects: increments in psychological empowerment, increments in perceived self- efficacy to practice HIV-safer sexual behavior, increments in perceived HIV-safe sex positive norms, and extent of community participation. During project year 05, diffusion-ready versions of the peer activist training intervention and assessment will be developed and diffusion programs will be piloted in four community-based organizations.
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