A 2008 UNAIDS report indicates that Sub Saharan Africa (SSA) accounts for only 10% of the world's population but 68% of adults and children living with HIV/AIDS with South Africa (5.7 million HIV/AIDS cases) and Tanzania (940,000 HIV/AIDS cases) accounting for more-than 6.5 million cases. In South Africa, young women account for 90% of new HIV cases and black South Africans are 9 times more likely than other racial/ethnic groups to contract HIV. Recent studies in Pretoria, South Africa have found HIV seropositive rates above 50% among young black women who use drugs and trade sex. In Dar es Salaam, Tanzania, recent studies suggest that the estimated prevalence of 12,000 injection drug users is rapidly increasing and that HIV rates in this group exceed 40% largely due to needle sharing. The proposed study is designed to address both the huge scale of the HIV pandemic in SSA countries by testing a brief intervention model that can feasibly reach huge numbers of drug users at elevated HIV risk while simultaneously testing a more intensive, couples' intervention that may be needed to foster behavior change among high risk groups disproportionately affected by HIV, including young women who use drugs and trade sex. The proposed study coordinates Randomized Controlled Trial (RCT) and Research Capacity Building (RCB) components to address priority areas of NIDA RFA-DA-10-008. The RCT study component will evaluate the efficacy of a brief motivational interview (BMI) and a cognitive-behavioral couples' (IFCBT) intervention alone and in combination against a comparison condition to reduce new cases of HIV and sexually transmitted infections and increase condom use and decrease sexual risk behavior, drug use, and intimate partner violence among young black female drug users in Pretoria, South Africa and their primary intimate partners. In the RCT, 384 couples comprised of young black female drug users who do (N = 192) and do not (N = 192) trade sex and their primary intimate heterosexual partners will be randomly assigned to one-of-four conditions: (1) testing and counseling; (2) brief motivational interview (BMI); (3) cognitive-behavioral couples' intervention (IFCBT); or (4) BMI and IFCBT combined. Eligibility criteria for couples include an HIV-negative drug using black female aged 18 to 29 and their primary intimate partner or spouse who is also HIV negative. Each partner of each couple will be administered assessments with blood tested for HIV and urine tested for Chlamydia, gonorrhea, trichomoniasis, and drug use at baseline and 3-month, 6-month, and 12-month follow-up. The RCB component will bring together researchers from South Africa, Tanzania, and the US to enhance opportunities for research collaboration, including oversight of the RCT study in Pretoria, and to plan and implement a pilot-test of the BMI and IFCBT interventions in Dar es Salaam, Tanzania.
Sub Saharan Africa accounts for only 10% of the world's population but 68% of adults and children living with HIV/AIDS with South Africa (5.7 million HIV/AIDS cases) and Tanzania (940,000 HIV/AIDS cases) accounting for more-than 6.5 million HIV cases. In South Africa, young women account for 90% of new HIV cases; black South Africans are nine times more likely to contract HIV than other racial/ethnic groups; and young black women who use drugs and trade sex exhibit HIV infection rates that exceed 50%. To reduce the spread of HIV in South Africa and Tanzania, the proposed study will test the efficacy of a brief motivational interview and a cognitive-behavioral couples' intervention in an effort to address both the enormous scope of the HIV pandemic in Sub Saharan Africa via the brief intervention while also testing a couples' intervention designed to target a wider range of risk factors that characterize subgroups at exceptionally high HIV risk, including young women who use drugs and trade sex.
