The primary objective of this four and one half year city-wide research demonstration project is to attract an increased number of intravenous drug users (IVDUs) to enter treatment; to improve drug free and methadone maintenance treatment programs and to educate persons about how to reduce behaviors associated with the spread of HIV infection. In an effort to reach IVDUs not in treatment, a community street outreach program will also be initiated. This research will be conducted in St. Louis, an area with currently low prevalence of reported AIDS cases, and high prevalence of intravenous drug use (IVDU). Specifically, we propose: (1) To establish new treatment slots for a methadone treatment and drug free treatment program located in the inner-city St. Louis area and to implement changes in their existing treatment protocols. (2) To recruit index subjects for a longitudinal study which will (a) evaluate improvements in the programs, (b) compare the efficacy of drug free treatment vs. methadone maintenance, a culturally-specific program vs. a racially generic program, and aftercare vs. no aftercare. The outcomes assessed will include: relapse to drug use, needle sharing and high risk sexual behaviors, program retention rate, employment, criminal activities and HIV seropositivity rates. (3) To identify individual characteristics which predict changes in outcomes among individuals regardless of treatment program. Specifically, through the use of standardized interviews, we will evaluate family history, and pre-admission and follow-up characteristics such as past and current psychiatric symptoms, lifetime abuse of and dependence on drugs and alcohol, high risk sexual behaviors, knowledge of HIV transmission, and needle sharing behavior. (4) To develop a community street outreach program to reduce high risk behaviors among high risk substance abusers not in treatment and their sexual partners. We will: (a) map areas of our city and county which are at high risk for illicit drug use and high risk sexual behaviors by imputation of data from the St. Louis Epidemiological Catchment Area survey; (b) collaborate with the Public Health Department to initiate a community street outreach program which will operate in the identified high risk areas to distribute vouchers for drug treatment, to provide crisis intervention for addicts who become HIV positive, and provide educational materials concerning prevention of HIV infection and drug abuse, and (c) evaluate the efficacy of this outreach program. (5) To disseminate information gathered from this study to drug treatment programs and health officials in the Metropolitan St. Louis area. (6) To further improve drug treatment services by conducting ethnographic interviews with clients concerning reasons for staying in or dropping out of their programs; and to raise awareness by having Junior High School students produce rap music about preventing drug abuse. (7) To recruit the subjects from this study for participation in other Washington University AIDS research studies and clinical trials.
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