This application proposes to investigate the family mechanisms by which Structural Ecosystems Therapy (SET; Mitrani et al, 2000) has its impact on HIV+ women in drug recovery. This proposed study is a companion to NIDA Grant DA15004 (SETA Protocol), which investigates the efficacy of SET in a clinical trial with HIV+ women who are in drug recovery. In the SETA Protocol, 176 women are randomly assigned to either SET or an HIV health group. The interventions last 4 months. SET works to transform the family system to reinforce sobriety, increase adherence with HIV medical care, and decrease sexual transmission risk behaviors in the target woman. The SETA Protocol only assesses the effect of SET on the recovering woman, not her family. Because SET targets changing the whole family as a means of helping the woman, we hypothesize that effects on the family as a whole (family functioning) and on individual family members will help to explain the woman's outcomes. The proposed study will enroll the women in the SETA Protocol and their families. A total of 528 family members are anticipated. Families are assessed at 4-month intervals for a period of 12 months. SET is hypothesized to affect family functioning (measured by self-report and observational methods). Changes in family functioning are hypothesized to affect the woman's drug abuse, HIV medication adherence, and HIV risk behaviors as well as the individual functioning of her family members (psychological distress, drug use and parent report of problem behaviors in children). The hypotheses will be tested using Latent Growth Curve Modeling. Understanding these mechanisms will facilitate the development of the next generation of family-based interventions for HIV+ women in drug recovery. This will be the first R01 award for this investigator. ? ?
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