Alternative Strategies in the Prevention on HIV/STDS

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DESCRIPTION (provided by applicant): This three-arm prospective experimental study of interventions to reduce high-risk sexual behaviors among 750 crack users will compare two behavioral interventions with a comparison group that receives usual HIV pretest- posttest counseling. Aims include (1) evaluating the effectiveness of the interventions, (2) examining changes in mediators of the intervention efforts, and (3) determining how well the interventions' effects are maintained over time. The two behavioral interventions are: (a) Project Respect, which has been demonstrated effective in changing sexual risk behaviors and is here applied to crack users; and (b) Project Respect Plus, modified by our investigators to specifically target alternative, less effective strategies for sexual risk-reduction that our formative research has shown to be common among crack smokers. This innovative intervention addresses the crack user lifestyle and the lay belief systems regarding HIV prevention in sexual situations. Outreach staff will recruit participants from six diverse neighborhoods in Miami/Dade County, Florida, and will randomly assign participants to one of the three arms using geographical randomization with a crossover design, which has been designed to reduce contamination within geographical and social groupings of drug users. This study design allows us to estimate the effects of each of the behavioral interventions over and above the impact of methodological effects (i.e. the effects of pre and post-test counseling and repeated measurement of behaviors). Sample size is sufficient to ensure adequate power to detect effects on sexual risk behavior. Follow-up over 18 months will allow us to assess how well the changes attributed to the interventions are sustained. The investigators have a long history of community-based research with similar populations.