Project Description. This application is a competing renewal of NI DA Grant # R01 DA13131, """"""""Brief HIV/HCV/HBV Interventions for Drug-Using Women Sex Workers."""""""" An important finding of this study was that a number of factors experienced by indigent, street-based, women sex workers - including childhood trauma, drug use, homelessness, street life, rape and violent victimization -- contribute to serious health problems among this population. These are most critical among African-American women in Miami, given their lower levels of economic resources, their location in Miami's most impoverished and neglected communities, as well as their higher rates of HIV and other sexually transmitted infections (STIs). In spite of the myriad of health and social problems among these women, numerous barriers prevent them from seeking and accessing needed services. The purpose of this competing renewal is to test innovative approaches designed to increase linkages and engagement with drug abuse treatment and other health services among this underserved population.
The specific aims of the proposed application are to: 1) assess the nature and extent of health service needs and barriers to service utilization among a sample of 550 drug-involved, indigent, African-American women recruited from inner city neighborhoods in downtown Miami;2) implement two alternative case management conditions designed to increase linkages to, and utilization of, appropriate health services by randomly assigning participants to: a Strengths-Based / Professional Only Condition in which clients participate in a """"""""strengths-based"""""""" case management approach;or, a Strengths-Based / Professional/Peer Condition in which a team composed of: a) a credentialed, professional case manager and b) a recovering addict/former sex worker-peer - both trained in """"""""strengths-based"""""""" case management techniques - develop and facilitate the implementation of a service plan;3) evaluate the effectiveness of these two conditions by conducting 3 and 6-month follow-ups with both clients and providers to determine extent of service linkages and outcomes of service utilization, as well as changes in risk behaviors as they relate to service access;and, 4) both across and between the two conditions, assess the patterns of interaction among predisposing, enabling, and illness/need factors, and examine their effects on services linkage and engagement at follow-up. Relevance to Public Health. Developing an effective mechanism for addressing the health and service needs of indigent drug-using African-American sex workers will improve the health status and the quality of life of the target population. In addition, because sex workers have contacts with multiple sexual partners, research that tests innovative approaches to treatment and service linkage has a benefit in terms of avoiding new HIV/STI infections, providing earlier access to medical treatment for those already infected, and reducing the spread of these infections to a wider population.
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