The proposed 5-year, Miami-based study is motivated by the need to develop and evaluate an alternative model of HIV/HCV/HBV risk reduction for drug-using women sex workers that is brief, cost- effective, easily replicable, and that goes beyond a purely didactic, expert-designed message. Training active sex workers as outreach workers and former sex workers as HIV/HCV/HBV interventionists, and designing an appropriate intervention together with members of this community are ways of empowering women sex workers to control their own risk reduction activities. As such, the general purposes of the study are to: 1) implement and evaluate the effectiveness of two interventions by randomly assigning 800 participants to one of two treatment conditions: a) a sex worker-focused intervention developed in conjunction with street-based sex workers and delivered by former sex workers; and b) a conventional intervention (the augmented """"""""NIDA Standard"""""""") delivered by former sex workers; 2) examine the effects of demographics and other variables in predicting changes in sexual, drug, and other risk behaviors; 3) examine the suitability of using active sex workers for outreach, and using former sex workers now in recovery for delivering the proposed interventions; 4) evaluate the cost and cost-effectiveness of the two interventions in reducing sexual and drug risk behaviors. The field site for the project will be located in the heart of Miami's major prostitution districts, and extensive pilot work was conducted to inform the development of the sex worker focused intervention and the proposal as a whole. The sample includes African-Americans, white-Anglos, and Latinas in proportion to their estimated representation in the active Miami sex worker population. Data analyses will use a variety of statistical techniques to describe the population and the prevalence of risk behaviors. Subsequent analyses will use advanced multivariate techniques to assess changes in risk behaviors. A vigorous publication and technology transfer program is proposed.
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