This revised competing continuation proposes to examine the long-term effects of the Women's CoOp intervention funded by the National Institute on Drug Abuse (NIDA). HIV surveillance indicates that underclass African-Americans in the South continue to be at high risk for HIV and face significant health disparities through poverty, unemployment, and homelessness. Intervention research has demonstrated that HIV is preventable through safer drug and sexual practices, and that HIV risk behaviors can and do change. However, African-American women who live in poverty experience unique social contexts that affect HIV risk. These contexts need to be addressed in sustaining HIV risk reduction. The Women's CoOp study has demonstrated that a gender-based, individualized HIV prevention intervention with inner-city African-American women who use crack cocaine is effective in reducing HIV risk behaviors and empowering these women to begin to change their social contexts of employment and homelessness. These findings suggest that the women who were able to positively change their social contexts by becoming employed or finding homes had greater reductions in sexual risk for HIV than those who remained unemployed or homeless. However, it is not known if these risk-reduction behaviors can be sustained over time. Many African-American women who live in high-risk communities face environmental stressors that may facilitate relapse to drug and sexual risk behaviors. The next empirical question for the Women's CoOp study is to determine the long-term effects of the Woman-Focused intervention with regard to drug and sexual risk for HIV, self-sufficiency, and a woman's ability to sustain change within her social context. Further, we posit that briefer interventions at regular intervals will be more effective in sustaining behavior change and be more cost-effective.
The specific aims of the proposed study are as follows:
Aim 1. To evaluate the long-term effectiveness of a culturally specific, woman-focused intervention relative to the NIDA standard intervention in terms of crack use and sexual risk behaviors and self-sufficiency (e.g., employment, housing).
Aim 2. To compare the effectiveness of a culturally specific, woman-focused booster follow-up intervention--relative to the NIDA standard booster follow-up intervention offered biannually--to sustain reductions in crack use and sexual risk and improve self-sufficiency at 6, 12, and 18 months post reenrollment among Women's CoOp participants.
Aim 3. To examine the mediating effects of employment and housing, as well as moderators, such as age, abuse history and psychological distress, on the effectiveness of the intervention at changing HIV risk behaviors at 6, 12, and 18 months post reenrollment.
Aim 4. To estimate the cost and cost-effectiveness of a culturally specific, woman-focused intervention relative to the NIDA standard in terms of crack use and sexual risk behaviors.
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