Among young African Americans IDUs, cases of HIV/AIDS continue to present a significant health crisis. In collaboration with the Orleans Parish Criminal Sheriffs Office (OPCSO), and local community based organizations, the investigators at Tulane and LSU Medical Schools in New Orleans and their consultants propose a 5-year study to develop, conduct, and evaluate a 3-arm HIV risk reduction intervention trial targeting young African American IDUs. Building on their previous work with young IDUs, the investigators will recruit a minimum of 638 young (ages 16-30) male and female HIV, HBV and HCV negative African American IDUs who are inmates with OPCSO. Eligible participants will be randomized to one of 3 intervention arms 1) A standard of care HIV counseling and testing intervention which will serve as the control arm, 2) a standard of care plus a structural pharmacy-based syringe purchase intervention which includes information on how and where to purchase sterile syringes, and 3) a standard of care and a structural pharmacy-based syringe purchase intervention plus a 4 session intensive client-centered behavioral intervention (CCBI) with boosters. Interventions will be implemented in standardized protocols beginning during incarceration at OPCSO when the participant is drug free and continuing when the participant is released from jail. Contact with participants will be of equal frequency and duration across all study arms. Participants in all arms will undergo baseline and 6, 12, 18 and 24-month follow- up assessments. The primary objective of the proposed study is to evaluate the differential rates of efficacy of the three intervention arms on reduction of HIV-related risk behaviors. Because HIV seroincidence is currently low in this population, engagement in direct and indirect syringe sharing is used as a surrogate marker for engagement in HIV and HCV-related risk behaviors and serves as the primary endpoint for this study. Secondary endpoints include: 1) participant self reports of sexual risk behaviors, 2) laboratory changes from baseline in HIV, HCV, and chlamydia status and 3) change in several factors (readiness to change, HIV/AIDS knowledge, attitude/motivation to change, self-efficacy, self-esteem, psychological symptomology, HIV risk reduction skills) hypothesized to mediate engagement in HIV risk behavior. Finally, economic analysis of the three intervention arms will be conducted. Results from this intervention study will address the HIV prevention needs of young African American IDUs and will have important implications for the development of successful large-scale risk reduction intervention programs.
