EXCEED THE SPACE PROVIDED. Women Teaching Women (WTW)is proposed by a team of Washington University investigators who havefocused on HIV prevention efforts among out-of-treatment injecting drug users (IDUs) and crack cocaine users, since 1988. Our peer- delivered prevention model was successful in reducing cocaine use among men. Webelieve no differences werefound in drug and sexual risk behaviors for women because the intervention lacked gender-specificity. Thus, we propose to tailor our previous intervention to women's needs to determine the shorter and intermediate term effectiveness of a gender- specific model on reducing drug use and sexual risks. This is the last time we can submit WTW and we are hopeful that our revisions have strengthened the science of this protocol. The urgency for women-focused interventions ishighlighted by increasing HIV/STD rates among women nationwide. The revised intervention is designed to bring the HIV prevention message to women in a public health environment. The three-arm intervention, which targets out-of-treatment drug-using women, will assess the differential impact of a woman-centered standard intervention alone, the same standard intervention plus a well-woman exam, and those plus the addition of 4 educational sessions. This proposal responds to two NIDA PAs: 95-083 (Women's HIV Risk and Protective Behaviors) and 96-018 (Drug Abuse Prevention Intervention for Women and Minorities).
Aims i nclude: 1. Recruit out-of-treatment female drug injectors, heroin, crack/cocaine and methamphetamine users into an intervention aimed at reducing high risk sexual and drug use behaviors. Street outreach, bars and clubs, shelters, health fairs and daycare facilities will be used to reach these vulnerable women at risk. 2. Administer a modified theory-based, peer-delivered, gender and culture-specific intervention that encourages women to reduce their high risk drug and sexual behaviors. 3. Assess the effectiveness of the interventions in reducing drug and sexual risk at 3 and 8 months post-intervention, controlling for baseline characteristics. 4. Evaluate the relative cost- effectiveness of each intervention. 5. Assess: a) incidence of HIV, Hepatitis B and C, syphilis, chlamydia and gonorrhea at 8 monthspost-intervention; b) change in HIVrisk and drug and alcohol use at 3 and 8 months post-intervention; c) the effect of psychopathology on behavior change at 8 months post-intervention; d) lifetime history of substance abuse and service utilization for mental and physical problems at baseline. 6. Disseminate findings to the scientific community, practitioners and community members.
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