Women in drug treatment are at high risk for HIV-infection because of high risk sexual activities and high risk sexual contexts often related to obtaining and consuming drugs; drug use; physiological vulnerability to sexually transmitted diseases and HIV; and social, cultural, and economic barriers which interfere with implementing self-protective behavior. This application proposes to compare (1) a Behavior Skills Training (BST) HIV-risk reduction intervention based on Social Cognitive Theory (2) an HIV-risk reduction intervention based on Motivational Enhancement (ME) and the Theory of Gender and Power; and (3) a control educational program in reproductive health (RH); One hundred fifty women in drug treatment will be recruited for each condition and will be evaluated during a 12 month follow-up period after discharge. Hypotheses are that both interventions compared to the control condition will (1) increase knowledge about HIV/AIDS, self-efficacy, attitudes toward condoms, and perceptions of social support for precautionary behavior; (2) decrease perceived barriers to condom use; (3) produce greater exchanges of condom redemption coupons; (4) increase the proportion of intercourse occasions which are condom-protected and decrease rates of unprotected sexual activity; and (5) decrease rates of needle-sharing among women who use injecting drugs. The BST intervention when compared with the ME intervention and the RH control, will improve social competency in safer sex negotiation and high risk refusal assessed through role play simulations. The ME intervention when compared with BST and the RH control, will increase self-efficacy, attitudes toward condom use perceptions of social support for precautionary behavior; (2) decrease perceived barriers to condom use; (3) produce greater exchanges of condom redemption coupons; (4) increase the proportion of intercourse occasions which are condom-protected and decrease rates of unprotected sexual activity; and (5) reduce rates of drug reinvolvement following discharge. By experimentally evaluating two theoretically driven HIV-risk reduction interventions and comparing both to a condition which controls for time, history, attention, and the effects of being in drug treatment, this study will attempt to identify a practical prevention intervention for women in drug treatment and assess maintenance and generalization for 12 months after discharge.
