SKILLS AND SELF HELP TO REDUCE HIV AND DRUG USE IN WOMEN

Women of African-, Caribbean-, and Latin/Hispanic-American descent are among the fastest growing segments of the population infected with the human immunodeficiency virus. Although injection drug use remains a critical element in the epidemiology of HIV transmission, heterosexual contact has recently eclipsed this mode of HIV exposure among women with diagnosed AIDS. Condom use remains low among female injection drug users. Some evidence points to a reduction in needle sharing and injecting among this population, but protective sexual practices have been adopted less readily. This study responds to the observed need for improved drug treatment as a means of slowing the spread of AIDS among women. Methadone maintenance reduces drug users' risk of contracting or transmitting HIV; yet sexual risk behavior, substance use, and program attrition remain serious problems among such patients. Needed are adjunctive interventions to boost the efficacy of methadone maintenance, while providing patients with skills to avoid contracting or HIV. Skills-training holds promise as a means of both improving drug treatment outcomes, and equipping individuals with the skills to avoid risk behavior. Twelve-step and other self-help approaches, once philosophically estranged from methadone maintenance, are increasingly seen as possible adjuncts to methadone maintenance treatment programs. Although a few studies have tested self- help approaches in methadone settings, few, if any such studies have developed interventions designed specifically for female patients at risk for AIDS. The investigation will test self-help as a strategy for slowing the spread of HIV among African-American and Latina women on methadone. In a randomized repeated measures design, the study will evaluate the processes, outcomes, and replicability of two forms of AIDS prevention groups: AIDS information with traditional 12-step fellowship support; and AIDS/relapse skills with structured self-help groups. The latter begin with sessions led by project, and continue with groups led and controlled by methadone clinic patients. A 12 month developmental/pilot period is followed by a 48 month intervention trial. Self-report, performance, and biological outcome measures, administered at baseline and on three follow-up will quantify cognitive, behavioral, and behavioral variables related to sexual risk-taking, drug use, and retention in program.