AIMS: Our major objectives are to evaluate: 1) a theoretical model regarding the mechanisms and processes associated with changing HIV risk behavior; 2) the impact of an Enhanced Psychoeducational (PE-E) HIV Risk Reduction training added to a drug abuse treatment program, compared to that of a conventional informational (INFO) HIV prevention procedure; and 3) to measure the influence of life events/social context variables (e.g., social support, resources, and stressors). Given the heuristic value of a theoretical model in developing effective prevention procedures, our study will be guided by the AIDS Risk Reduction Model (ARRM; Catania et al., 1990, 1994). The proposed project will be among the first to evaluate a psychoeducation intervention for our target population of socioeconomically disadvantaged, """"""""crack"""""""" cocaine abusing, pregnant and postpartum, African American women at high risk for HIV that includes their male primary sex partners (PSPs). HYPOTHESES: Hypotheses are that: 1) greater levels of intervention implementation will predict greater positive change in post-treatment and follow-up levels of the ARRM mediating and HIV risk reduction outcome variables; 2) greater positive change in the ARRM mediating variables will predict greater change in HIV risk reduction outcome variables; 3) because our target sample is indigent, """"""""disempowered"""""""", substance abusing women, social context variables will be significantly related to HIV risk reduction outcome; 4) PE-E will produce greater positive changes in ARRM and social context mediating variables than INFO; and 5) PE-E will be most effective for subjects showing the greatest initial problems in ARRM and social context mediating variables. METHOD: Our target sample of women in substance abuse treatment (n=160) will be assigned using a random block design to a) the INFO condition in which subjects receive two session of didactic HIV transmission and risk reduction information, or b) the PE-E condition in which subjects participate in multiple HIV risk reduction sessions with their primary sex partner. Adherence to experimental end control conditions will be monitored and carefully documented. Risk behavior, drug use, HIV serostatus, and other clinically significant phenomena will be measured at pre- and post-intervention and at 3, 6, and 12 months. ANALYSES: To ensure that data are reliable and valid, correlational techniques will be used to assess levels of agreement between self-report and other converging information sources. Data analyses will involve a 2- way (intervention condition x time) factorial design (e.g., MANCOVA or ANCOVA). Analyses will include survival curves, multivariate logistic regression and factor analyses to reduce the number of variables. Step- wise multiple linear regression analyses will be used to evaluate the ARRM constructs and to identify baseline variables that predict a successful response for each treatment condition.
