This resubmission of our proposal entitled """"""""The Impact of Neighborhoods, Networks, and Depression on Drug User's HIV Risks (1R01 DA022961-01A1) targets inner-city African Americans who have disproportionately high rates of drug abuse and HIV infection. Among drug users, unprotected sexual activity is increasingly contributing to new HIV infections. Social network characteristics and urban neighborhood conditions of crime, violence, physical decay, drug use, residential mobility, unemployment, incarceration, and crowding may directly and indirectly contribute to HIV transmission. In our prior research, depressive symptoms were found to be a key mediator between neighborhood characteristics and HIV risk behaviors. The major goal of the study is to implement and evaluate a randomized controlled, phase II depression intervention to reduce drug and sexual HIV risk behaviors and depressive symptoms among inner city opiate and crack cocaine users. Another study goal is to examine the relationships among neighborhood characteristics, social network factors, depressive symptoms and other individual-level factors, and HIV risk behaviors among a sample of 700 inner-city crack cocaine and opiate users. The proposed study will allow us to examine the dynamic relationship between depressive symptoms, drug abuse, and drug and sexual HIV risk behaviors. Depression has also been found to be associated with relapse of drug use after drug treatment and deleterious medical conditions. Moreover, among people living with HIV/AIDS, depressive symptoms are linked to lower levels of HIV medical adherence. The experimental intervention, which is based on our prior HIV prevention interventions and pilot depression intervention, will integrate HIV prevention training with cognitive behavioral therapy for depression, targeting depressive cognitions and behaviors that are hypothesized to increase HIV sexual and drug risk behaviors. The proposed study will recruit a sample of 500 crack smokers and 500 injection drug users in inner-city Baltimore, Maryland. The sample will be African American and 40% female. Half of the participants (n=500), those who have high levels of depressive symptoms (CES-D =16), will be randomly assigned to either the 10 session small group experimental intervention or equal attention control group. The control condition will be comprised of a drug overdose prevention training. Participants in the intervention (N=500) and a sample of individuals with low levels of depressive symptoms (n=200) will be assessed at baseline, and at 3-, 6-, 12-, and 18-months. Interviews and specimen testing for HIV antibodies and drug metabolites will be conducted. In addition to survey data, observer ratings of neighborhoods, police crime reports, and census data will be collected. Hierarchical Linear Modeling and Structural Equations Modeling will be used for data analysis.
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