Research Project
2357060
This 5 year project, in response to PA 94-054, will test theoretically informed interventions to reduce sexual risks of HIV infection among chronic. out-of-treatment crack cocaine smokers and their sexual partners in Washington, D.C. The study has two related purposes, First. the study will identify the cognitive, social and behavioral precursors of HIV risk reduction related to sexual activities and apply this information to the development of interventions to reduce risky sexual behavior. Second, the study will empirically test the efficacy of developed interventions to reduce sexual risk. The study will be conducted in 2 phases. Both phases of the study will be informed by theory of reasoned action and trans- theoretical model of behavior change. Phase 1 is an exploratory phase composed of two components. Component 1a is a qualitative study to elicit the range of cognitive, social and environmental factors that influence sexual risk reduction behaviors. The specific aims of component 1a are: 1) to identify behavioral and normative beliefs and skills of individuals, together with social support, social network, and environmental factors that influence adoption of sexual risk reduction behaviors and 2) to identify demographic, drug use, and other personal history factors relate to sexual risk reduction. During phase 1a, semi-structured in depth interviews and focus groups will be conducted. Component 1b is a study to examine the generalizability of information generated in phase 1a. To conduct phase 1b, a quantitative questionnaire will be developed, based upon the information obtained in Component 1a. The questionnaire will be administered to 240 crack cocaine smokers and sex workers who smoke crack cocaine. The specific aim of Phase 1b is to determine the interrelationships among behavioral mediators to risk reduction, such as intention or self-efficacy, and examine how they vary by individual, social, and environmental conditions. The data collected during this phase will be analyzed using exploratory methods such as factor and cluster analyses and structural equation modeling. A second, related part of the phase 1b study is an evaluation of the efficacy of minimal HIV testing and counseling as a risk reduction strategy. This information will be combined to develop and evaluate behavior change interventions in Phase 2. Phase 2 of the study will test 2 interventions developed to reduce sexual risks. Phase 2 of the study will recruit 720 subjects who will be randomly assigned within stage of change strata. Random assignment will be to one of two risk reduction interventions or a control group. One intervention will target behavioral beliefs and the other self-efficacy. The behavioral beliefs intervention will use Motivational Interviewing (Miller & Rollnick 1991) and target increasing the importance of the pros and cons and self- motivation for change. The self-efficacy intervention will target performance accomplishment. vicarious experience, verbal persuasion. and emotional arousal (Bandura 1977 & Bandura 1982). The control group will receive a general health enhancement intervention. It is hypothesized that the constructs (e.g. behavioral beliefs or self-efficacy) in the Theory of Reasoned Action will be significant predictors of specific HIV risk behaviors. In addition, different constructs will be more or less important to subgroups of chronic drug users (e.g. female crack smoking prostitutes vs. male crack users who inject) and to subjects in different stages of change. Although this project is an individual study with recruitment and data collection located in Washington, D.C., it is also a multi-site IRPG study. Data from Washington. D.C. will be combined with data from six other participating sites to increase the statistical power of all phases and the generalizability of findings generated by the study.
