This application is a revision to R01DA032217-01. With the growing number of HIV seropositives in the US, there is a need for increasing secondary prevention and optimizing primary HIV medical care. As many seropositives are unaware of their serostatus there is also a need for increased VCT programs that reach high risk individuals. Our prior social network oriented interventions have demonstrated diffusion of risk reduction and the ability to recruit seropositive injection drug users (IDUs). Given the substantial rates of sexual HIV transmission and high levels of drug resistant HIV among IDUs, as well as the chronic nature of injection drug use, there is a need for effective behavioral intervention strategies that address risk behaviors among IDUs and their risk network members that can be sustained.. There is also an urgent need to develop programs to engage and retain vulnerable drug using people living with HIV/AIDS (PLHAs) in primary HIV medical care. Engagement in HIV primary care has been found to predict virologic and clinical outcomes. Low and inconsistent engagement in HIV primary care contributes to African Americans' and IDUs' higher HIV morbidity and mortality rates compared to other HIV racial or exposure groups. The main goal of the proposed study, which builds on our prior interventions is to train IDU PHLAs to be peer health educators will (1) recruit high risk network members for VCT, (2) promote network risk reduction, and (3) promote engagement in HIV care and treatment by encouraging their HIV seropositive network members to schedule and keep HIV primary care appointments, realistic patient-provider role expectations, and social norms of discussing HIV medical care. We propose recruiting and randomly assigning half of 300 IDUs PLHAs (termed indexes), predominantly African American, to an experimental peer health educator training and half to an attention control condition. Participants in both conditions will be encouraged to recruit high ris network members for VCT. We anticipate 270 networks will enroll. To enhance sustainability of intervention effects, experimental participants and their network members will be offered support sessions on HIV care. We expect that the peer health educator role will be perceived as meaningful to IDUs, who have minimal opportunities for prosocial roles, and that social rewards will help sustain peer health education and social diffusion of intervention effects. Moreover this approach can provide PLHA with training in goal setting, problem solving, and communication skills that can be applied to personal and professional situations.
This study represents a low cost, sustainable intervention approach, with potential high impact by reaching and engaging drug users, PLHAs, and other community members in primary and secondary HIV prevention. The intervention will also promote VCT and optimization of HIV primary medical care. The proposed intervention is designed to diffuse behavior change to social networks members and provide meaning for social roles for peer health educators.
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