This proposal is an investigator generated innovative research design consistent with the National Institute on Drug Abuse's request for applications, 94-054, """"""""Strategies to Reduce HIV Sexual Risk Practices in Drug Users."""""""" The intersection of crack cocaine and high-risk sexual activity is a major factor propelling new HIV infections in the United States. Heterosexual African Americans who reside in concentrated urban areas are at especially high risk for HIV infection. The mechanisms of infection include increased numbers of sex partners, high rates of STDs, and sex for drugs or money exchanges. The purpose of this proposed study, A Test of a Peer Self-Efficacy Intervention, is to evaluate an HIV risk reduction intervention targeting African American crack cocaine smokers. The intervention will test the effect of a peer delivered self-efficacy intervention on condom use and condom use self-efficacy beliefs at the individual level. The intervention is derived from Bandura's Social Cognitive Theory. The Peer Self-Efficacy Intervention will be compared to a """"""""standard care"""""""" HIV risk reduction intervention, the Peer NIDA Intervention. The sample for the study is not-in-treatment African American crack cocaine smokers residing in two targeted communities in Houston, Texas. The study is designed to specifically test the effects of peer interaction and intervention content on condom use behaviors and condom use self-efficacy beliefs. The design of the proposed study is a longitudinal cohort design. The design takes into account the reality of conducting research with not-in-treatment drug users. To examine the effects of the intervention on individual level condom use and self-efficacy beliefs, two matched neighborhoods will be randomly assigned to receive either the PSE Intervention or the comparison intervention. The comparison intervention is the """"""""standard care"""""""" prevention model. In each neighborhood selected for the study, 200 crack cocaine smokers will be randomly selected from 600 crack smokers participating in a baseline study to take part in a longitudinal study. Participants in the longitudinal study will receive the intervention assigned to their community. Intervention activities will occur between months 1 and 3 of the behavioral study. Measurement of condom use and condom use self-efficacy beliefs outcomes will be at 6 and 12 months after baseline measurement. Outcomes of interest will be condom use, condom use self-efficacy beliefs, and the motivational and normative factors that have an impact on self-efficacy beliefs.
