A THERAPEUTIC WORKPLACE TO PREVENT HIV TRANSMISSION Intravenous drug users who are infected with the human immunodeficiency virus (HIV) are at considerable risk for spreading HIV infection through the sharing of infection equipment. Reducing or eliminating drug use in this critical population may be an unusually efficient and effective means of preventing the spread of HIV infection, and herein lies the crux of this proposal: We propose to evaluate a novel drug-abuse treatment program of proven efficiency, the Therapeutic Workplace, in a population of HIV positive, intravenous drug abusers. The intervention integrates abstinence reinforcement contingencies into a model supported work program. Patients are paid to perform data entry jobs in the Therapeutic Workplace. Those lacking needed skills are given intensive training. To reinforce and promote drug abstinence, patients are required to provide a drug free urine sample to gain entrance to the workplace each day. In this way, patients can work and earn salary only when they abstain from drugs. Patients are paid in vouchers instead of cash to reduce the chance they will use their earning to purchase drugs. A randomized trial is planned over 5 years to evaluate the efficacy of this intervention and to assess the contribution of the abstinence reinforcement component in adult intravenous drug abusers who are HIV positive and who complete an inpatient drug and alcohol detoxification. After the detoxification, 156 participants will be invited to attend the workplace for 6 months and randomly assigned to one or three groups that will differ in the requirements of voucher reinforcement. One group will receive the full therapeutic workplace intervention in which vouchers are contingent on both abstinence and work. A second group will be paid for work, but will not have to provide a drug-free urine sample to gain access to the workplace (vouchers contingent on work only). A third group will receive vouchers on a non-contingent basis. This group will control for the increases in wealth associated with voucher reinforcement. Critical measures of drug use and HIV risk behaviors will be assessed. We expect the most abstinence when both abstinence and work are required to earn vouchers. This study will allow for the rigorous evaluation of a novel approach to the treatment of drug abuse, the Therapeutic Workplace, in HIV positive, intravenous drug abusers; and provide critical information on the potential of this intervention to serve as a targeted strategy to prevent the spread of HIV infection.
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