The study proposed in this application, Positive Choices Research Project builds on and continues work we began as part of a grant, """"""""Condom use among drug users receiving antiretroviral medications, """"""""R03 DA12318-01. The purpose of the Positive Choices Research Project is to evaluate the efficacy of a risk reduction protocol designed to reduce the sexual transmission of HIV by crack cocaine smokers receiving medical treatment for HIV disease. Specially, the purpose of the risk reduction protocol is to increase condom use during vaginal/anal intercourse. To evaluate the efficacy of the risk reduction protocol, we will implement a randomized clinical field trial. The trial will compare the Positive Choices risk reduction intervention to the current standard intervention for drug users in non-clinical settings. Bandura's Social Cognitive Theory (SCT) is the theoretical framework underpinning the Positive Choices intervention and the study design. The intervention methodology is cognitive mapping, a strategy that has been successfully used in drug treatment and is very compatible with SCT. Assessment of the effectiveness of the intervention will be based on data collected at completion of the intervention and at 3 and 9 months after completion of the intervention. This is the first study of which we are aware of that will investigate the efficacy of an intervention to increase condom use targeting HIV+ crack cocaine smokers. The Positive Choices Research Project has important scientific and pubic health implications. As the comparatively small number of studies in this areas shows, less than half of any sample of HIV positive (HIV+) drug users consistently use condoms. The psychosocial precursors that influence adoption of risk reduction practices may not be the same as those that influence maintenance of long-term behaviors. It is difficult to generalize from studies focusing on MSM. As a recent review of the literature concludes, heterosexual men are socialized to believe that only unprotected vaginal sex is sex. The Positive Choices Research Project will be tested in Houston, Texas. Houston is the nation's fourth largest city and has the sixth highest AIDS caseload. The city's caseload reflects the makeup of its population. Forty-five percent of cases are White, 38% African American, and 17% Hispanic. Seventeen percent of the caseload is female. Since 1994, more heterosexuals had been diagnosed with AIDS in Houston than any other group. The city has the unpleasant distinction of having the highest rate of new heterosexual infections in the United States. The epidemic among heterosexuals in Houston is focused in the African American community. About one-third of newly infected African Americans are women. The disease in the African American community is directly and indirectly linked to the crack cocaine epidemic. ? ?
