Women in treatment for alcohol problems are at heightened risk for infection with HIV. Alcohol use may contribute directly or indirectly to risk in this population. Other factors that may contribute to risk include individual-level characteristics (e.g., psychological distress; alcohol expectancies for risky behavior), as well as contextual characteristics associated with specific partners and relationships (e.g., negative partner attitudes toward condom use). Alcohol use and other factors can be conceptualized as operating through their influence on constructs represented in the Information-Motivation-Behavioral Skills (1MB) model of HIV preventive behavior. For the proposed project, an ethnically diverse sample of women entering either outpatient (n = 300) or inpatient (n = 150) treatment for alcohol abuse or dependence will be interviewed on five occasions: shortly after admission to treatment, and 3, 6, 9 and 12 months following the initial interview. Interviews will assess alcohol and other substance use, sexual behavior, and a range of individual and contextual variables that may affect HIV risk. Each interview will include administration of a 90-day Timeline Follow-Back to obtain a retrospective, daily assessment of substance use and sexual behavior, and detailed event assessments for the most recent occurrence of sexual intercourse and for the first occasion of intercourse with the most recent new sexual partner (if any). The proposed research will achieve the following specific aims: (1) To evaluate cross-sectionally, both prior to and following women's entry into treatment, model-derived hypotheses regarding the acute and global relationships of alcohol use and other factors to HIV risk-related behavior (as characterized by non-use of condoms during sexual intercourse, having multiple and/or casual sexual partners, and not discussing risk-related topics prior to having sex); (2) To evaluate prospectively hypotheses regarding the extent to which baseline characteristics are predictive of subsequent change in HIV risk behavior following entry into alcoholism treatment; and (3) To evaluate prospectively hypotheses regarding the extent to which women's treatment participation, exposure to HIV risk-reduction education and counseling, and changes in alcohol use mediate changes in IMB-related constructs and HIV risk-related behavior. The proposed research, guided by empirically supported models of HIV prevention behavior and alcohol effects, will provide a strong foundation for subsequent development of effective, efficient, targeted HIV prevention for women in alcoholism treatment.
