This revised application is in response to NIDA's (DA-90-02) call for cooperative agreements to address the need for developing and rigorously evaluating comprehensive models for HIV/AIDS outreach and intervention with injection drugs users (IDUs). Through North Carolina is dominated by numerous medium-sized urban areas and small farming communities, its cities have some of the highest per capita rates of infant mortality and sexually transmitted diseases and the number of AIDS cases in the state has doubled in the last two years. Particularly hard hit are African- American women, who are six times more likely to give birth to HIV- infected infants than are white women, and are currently the state's primary recipient of heterosexual transmission. Current outreach efforts have also largely been limited to the inner-city areas and thus miss over half of the estimated IDUs, particularly under representing young adults under the age of 30. The proposed research will develop social networking and feedback components to supplement the standard protocols set forth in the NIDA (1991) cooperative agreement and independently evaluate the two major aspects of community outreach to IDUs (recruitment and intervention) in two randomly controlled trials.
The specific aims are to: (1) develop strategies for HIV/AIDS outreach recruitment and intervention that use social network, social learning, and psychoeducational theory to enhance the standard protocols set forth in the NIDA (1991) cooperative agreement; (2) conduct a randomly controlled trial with 141 geographic HIV/AIDS strategies for identifying and recruiting IDUs in general and specifically those who are African American women, and/or under 30: (3) conduct a randomly controlled trial with approximately 1,300 IDUs identified in the recruitment experiment to examine the relative effectiveness of standard and social feedback HIV/AIDS outreach interventions in terms of IDUs entering treatment, going to support groups, increasing other preventive behaviors, and decreasing risk behaviors; and (4) examine the marginal cost effectiveness of the standard and social outreach recruitment and intervention strategies. The critical component of the social networking experiment is for outreach workers to work through informal community leaders and previously identified IDUs to locate other IDUs, who might not be reached through the inner-city sidewalk patrols that were typical of early outreach efforts. The critical component of the social feedback experiment is to personalize information and recommendation about AIDS- related risk and preventive behaviors. This will be done through immediate feedback on an individual's behavior and relative risk factors, comparisons to the behaviors of other IDUs, assistance in entering treatment, provision of both general risk reduction packages and personal referrals, presentation of peer-based examples of people who have changed, and through peer-group counseling led by people who have changed their drug-related behavior and/or who may have HIV infection. The data will include screeners, locator form pre- and post-intervention interview, urine tests for drugs, blood tests for HIV, service logs, and cost work sheets.
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