The purpose of this project is to determine the relative effectiveness of three models of drug abuse treatment and AIDS prevention/intervention within a population of parolees that is at high risk for HIV and AIDS. The levels represented in comparison are an intensive inpatient therapeutic community approach (TC), an intensive outpatient approach (ACT) and education on risk behaviors only (PS) approach. A case management treatment program will be established utilizing an Assertive Community Treatment (ACT) model. 200 clients will be selected at random for placement in this program as a condition of early parole ACT is a continuity of care model borrowed from the mental health field. In addition to intensive treatment, vocational training, and instrumental support, ACT clients will receive intensive AIDS prevention education. 200 clients will be randomly assigned to normal parole supervision (PS), with intensive AIDS prevention education. There will be comparison group of 100 clients paroled from a prison based therapeutic community (TC). All three groups will receive urine and HIV testing, and assessments with the Addiction Severity Index (ASI) and the NIDA AIDS Initial Assessment (AIA) questionnaire, immediately prior to their release from prison. All clients will be reassessed 6 months and 18 months subsequent to release. The study population will be 20% female and 80% male;50% black and 50% white. Parolees with histories of violence or serious sex offenses will be excluded from the sample pool. Data analysis will use standard experimental comparison techniques for the comparisons of interventions with success criteria established in terms of self-reports of drug abstinence and physical test results. Also, discriminant function analyses will evaluate other potential factors leading to significant differences in success outcomes. Result of this research will provide important information on treatment alternatives for a particularly high risk group for HIV infection. This group's exposure has been limited by incarceration, but under normal relapse rates for paroled addicts, they are a potential prime source for extending HIV infection in the population. Intervention at this stage should be a cost-effective public health benefit.
