The broad objective of this proposal is to identify effective culturally sensitive interventions to reduce the risk of sexually transmitted diseases (STDs), including HIV, among inner-city African American women who abuse substances. We will randomly assign 869 African American substance abusing women from an inpatient detoxification program serving a low-income community in Philadelphia, PA to one of two conditions: (a) a 2- session skill-building HIV risk-reduction intervention or (b) a 2-session general health promotion intervention concerning health issues unrelated to sexual behavior, which will serve as the control group. The women will also receive booster interventions at the 3- and 6-month follow-up sessions. The interventions will include films, role-playing, and interactive activities led by a specially trained facilitator. The approach draws on Bandura's social cognitive theory, Fishbein and Ajzen's theory of reasoned action, its extension, the theory of planned behavior; focus groups with substance abusing African American women; and the applicant's previous HIV risk-reduction research with inner-city African American populations, including substance abusing women. The primary outcome measures are self-reported frequency of sexual intercourse, unprotected sexual intercourse, and condom use. Secondary outcome measures include STDs, condom coupon redemption, and theoretically relevant variables hypothesized to mediate intervention effects, including intentions, beliefs, and self-efficacy. We will use audio computer-assisted self- interviewing (audio-CASI) to collect data before, immediately postintervention, and at 3-, 6-, 12-, and 18-month follow-up. We will perform ligase chain reaction tests to detect STDs in urine specimens collected at baseline and 6-, 12-, and 18-month follow- up. To address the Specific Aims, we will analyze the data with generalized estimating equations (GEE). We will test (a) the effects of the interventions on unprotected sexual intercourse, condom coupon redemption, STD incidence, and mediators of sexual behavior and (b) whether intervention effects are systematically different depending on key moderator variables, including participants' history of substance abuse, history of drug treatment, HIV serostatus, sexual abuse history, relationship status, and depression. The results of this project will contribute to the development of efficient and effective HIV prevention programs for inner-city African American women who abuse substances.
