Spirituality Guided HIV Prevention For Drug Users

描述（由申请人提供）： 尽管美国广泛奉行宗教习俗，但精神或宗教信仰作为预防吸毒者感染艾滋病毒和其他感染的一种资源的作用一直是相对较少的实证调查的重点。针对RFA-DA-02-009“预防吸毒者艾滋病毒/其他感染的新方法”，我们建议开展一个第一阶段行为治疗项目，该项目将开发和试点测试一种创新的动机干预-精神自我图式（3-S）疗法-以减少利用患者精神和宗教信仰在内城吸毒者中传播艾滋病毒和其他感染的行为。3-S疗法是基于自我图式和自我调节的行为模式。激活的自我图式建立了调节注意力的选择标准，为编码、存储和检索信息提供了焦点和结构，并与系统的其他组成部分（如情绪和生理）有着强有力的关联。3-S疗法的治疗目标是促进客户的工作自我图式的转变，从频繁激活的“成瘾”自我图式到患者定义的“精神”自我图式的激活，这种自我图式与艾滋病毒预防和其他亲社会行为相容，与导致感染或传播艾滋病毒和其他传染病的行为不相容。第一阶段的具体目标有三个方面：1）在艾滋病预防行为的信息-行为-动机（IMB）总体模型内，开发和完善3-S疗法，包括手册开发和编纂; 2）开发和评估3-S疗法培训计划;和3）进行初步的3-S治疗的随机试验，将比较个体和团体形式的3-S与美沙酮维持患者的增强标准护理。68例美沙酮维持治疗患者将参与这些研究。主要结果将是保留治疗和减少非法药物使用，性和药物相关的风险行为。为了探索干预措施的可移植性，我们还将进行一项可行性评估，在三个非临床社区环境中提供3-S小组模式-当地教堂，无家可归者收容所和艾滋病服务组织。

DESCRIPTION (provided by applicant): Despite the wide observance of religious practice in the United States, the role of spiritual or religious faith as a resource for preventing HIV and other infection in drug users has been the focus of relatively few empirical investigations. In response to RFA-DA-02-009, "New approaches to prevent HIV/other infections in drug users", we propose to conduct a Stage I behavioral therapy project that will develop and pilot test an innovative motivational intervention -- Spiritual Self-Schema (3-S) Therapy - for reducing behaviors that transmit HIV and other infections among inner-city drug users that taps into patients' spiritual and religious beliefs. 3-S therapy is based on self-schema and self-regulation models of behavior. An activated self-schema establishes selection criteria for regulating attention, provides focus and structure for encoding, storing and retrieving information, and has strong associative links to other components of the system, such as emotions and physiology. The therapeutic goal of 3-S therapy is to facilitate a shift in the client's working self-schema, from the frequently activated "addict" self-schema to the activation of a patient-defined "spiritual" self-schema that is compatible with HIV preventive and other pro-social behaviors and that is incompatible with behaviors that lead to contracting or transmitting HIV and other infectious diseases. The specific aims of this Stage I are threefold: 1) within an overall Information-Behavioral-Motivational (IMB) model of HIV preventive behavior, to develop and refine 3-S therapy, including manual development and codification; 2) to develop and evaluate a 3-S therapy training program; and 3) to conduct a preliminary randomized trial of 3-S therapy that will compare individual and group modality versions of 3-S to enhanced standard care in methadone-maintained patients. Sixty-eight methadone-maintained patients will participate in these studies. Primary outcomes will be retention in treatment and reductions in illicit drug use, sex- and drug-related risk behaviors. In order to explore transportability of the intervention, we will also conduct a feasibility assessment of providing the 3-S group modality in three non-clinical community settings - a local church, a homeless shelter, and an AIDS service organization.