The Dayton-Columbus National AIDS Demonstration Research (NADR) and the Dayton Crack Cocaine Outreach Prevention Project have completed two years of work sampling over 1200 IDUs and their sexual partners and 100 crack cocaine users. While the follow-up is still ongoing, sufficient preliminary information exists to provide direction in building upon the findings of these programs. Based on the existing preliminary data, it is the purpose of this 5-year, proposed regional project, using indicator identification points as well as a street outreach methodology, to continue monitoring the HIV prevalence and risk behavior rates and testing the efficacy of three intervention programs with this drug-using population in Dayton-Columbus. Because the prevalence of HIV infection is presently low in Dayton-Columbus, it is very important to continue monitoring community prevalence in order to detect any significant changes in that infection rate. Given the number of identified drug users, the extent of high risk behaviors and the presence of HIV, there is a high probability that the virus will spread. Dayton- Columbus represent a unique opportunity to prevent the spread of HIV infection in a community at risk. All of the elements for the spread of infection are present; the virus, the risk population and the risk behavior. In the Dayton-Columbus region of southwestern Ohio, AIDS prevention can still make a difference. Over two thousand (2,000) IDUs, crack cocaine users, and their sexual partners will be screened for inclusion in the study and all eligible subjects will be randomly assigned to one of three groups: (1) conventional pre-and post-test counseling under the standard CDC protocol, (2) those who receive the """"""""enhanced"""""""" intervention currently used in our outreach programs, and (3) those who receive the enhanced intervention plus an intensive case management/advocacy program, which will consist of a complete assessment of treatment and other service needs and a plan to meet those needs. The project preliminary data indicate that the extensive problems evident in the information obtained from current subjects can be best addressed using an intensive case management intervention design. It is estimated that approximately 600 drug users and their sexual partners will be randomly assigned to each group. MANOVA techniques will be used to examine the significance of differences in changes in HIV risk behavior between the three groups. It is expected that the group assigned to intensive case management will have the largest significant reduction in HIV risk behavior.
