Although HIV rates among women continue to increase, HIV interventions addressing the unique circumstances of women (e.g., gender role expectations and gender power differences) are limited. Many women are at risk for HIV infection through their own or their sex partner's injection drug use and through involvement in high-risk sexual activities. The proposed study will be conducted in two phases. During Phase 1 (12 months) qualitative/elicitation research will be conducted and gender-specific interventions will be developed for three comparison groups of women: (1) injection drug users, (2) crack cocaine users, and (3) non-using sex partners of male injection users. All women will reside in one of two Atlanta communities, be 18 years or older, be African American, and fit the eligibility criteria for one of the three comparison groups. Women will be recruited through targeted sampling and grounded theory will guide the data analysis. Phase 1 will be followed by the actual implementation and evaluation phase (36 months) in which three intervention conditions are compared: (1) standard intervention; (2) enhanced motivation intervention; and (3) enhanced negotiation intervention among the comparison groups. The interventions will include five intensive individual encounters between the women and their community health interventionist. The enhanced interventions will be guided by respectively motivational interviewing and the health negotiation model (derived from sociopsychological theories addressing behavior change such as the theory of reasoned action, the theory of planned behavior, the health belief model, and the transtheoretical model of behavioral change). A randomized block design will be used to allocate women to one of the intervention conditions. Phase 2 data collection includes: two-part pre-intervention interviews, including HIV counseling and testing, post-intervention interviews, and 6-month follow-up interviews, including HIV counseling and testing. Data analysis will include ANOVAs with orthogonal a priori group contrasts and ANCOVAs and examinations of moderator and mediator variables via hierarchical multiple regression. The main goal of the proposed study is to develop gender-specific interventions for women at-risk for HIV infection.
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