HIV prevention messages have typically targeted uninfected, at-risk individuals and have focused on forestalling the acquisition of HIV. Recently, a shift in the HIV prevention field has recognized the importance of developing intervention strategies for HIV-positive individuals, since each new infection begins with someone who is already HIV-infected. Prior studies show that many HIV-positive individuals are continuing to engage in unsafe risk behaviors and that crack use is significantly associated with these risk behaviors. These data also show that crack use is negatively associated with the use of primary outpatient HIV care. The hospital or inpatient ward may be an important, yet largely untapped setting to provide prevention interventions to high-risk, HIV-positive crack users. Hospitals also provide an important setting for HIV prevention interventions with infected crack users, because hospitalization may serve as a """"""""teachable moment"""""""" when patients are open to behavioral change interventions. Our multi-site study between the University of Miami and Emory University will be conducted at Jackson Memorial Hospital in Miami, Florida and Grady Memorial Hospital in Atlanta, Georgia. We will evaluate the efficacy of a brief, theoretically-guided, """"""""Prevention Care Advocate"""""""" intervention with HIV-positive crack users recruited from the HIV inpatient hospital wards at Jackson and Grady hospitals. We will provide a multicomponent, skills-building intervention that encourages participants to advocate for prevention and receipt of primary care services for themselves and their peers. These intervention strategies are adapted from strategies recently developed and tested in previous CDC-funded multi-site studies. We will employ a randomized experimental design to compare the intervention's efficacy with an attention-control group. Participants will be assessed at baseline and 6 and 12 months after completing the intervention. The primary outcome of the study will be to reduce unprotected sex. Secondary outcomes will include increasing the use of HIV primary outpatient cars and increasing readiness for and entry to drug treatment.
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