Modifying Safer Sex Skill Building (SSB) to Prevent HIV in Alcohol Abusing Women

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DESCRIPTION (provided by applicant): The lifestyle of alcohol and drug dependent women often places them at increased risk for psychological and medical sequelae. HIV/STD infection is no exception. While participation in substance abuse treatment has been found to be effective in reducing drug use, research to date has demonstrated a relatively low success rate with regard to reducing sexual risk behaviors. Rather, socio-cultural and contextual factors have been reported as barriers to condom use and sexual negotiation. One promising approach, is "Safer Sex Skill Building" (SSB), a 5-session, manual-driven intervention by Schilling and colleagues (1991). Women randomly assigned to SSB reported increased condom use and other safe sex practices compared to women receiving standard HIV education. The SSB intervention, however, was developed primarily for women with one or more illicit drug problems. Much less attention was given to alcohol use disorders and their contribution to high risk sexual behaviors, which are more prevalent. This B-START proposal seeks to further enhance the SSB curriculum by adding "alcohol risk awareness" and "alcohol use context" components to existing modules (SSB+A), enabling women to create a mosaic of the pattern of alcohol and drug use that leads to risky sexual behavior and the social and relationship environment in which this occurs. Using the Rounsaville et al (2001) Stage Model of Behavioral Therapies Research, this B-START application will: a) develop and pilot test SSB+A in a sample of women of childbearing age with alcohol use disorders; b) revise the SSB+A intervention with both participant and expert panel feedback; and c) conduct a small randomized clinical trial comparing SSB+A to a one session standard HIV education group. Subjects will be alcohol abusing or dependent women of childbearing age who are enrolled in residential treatment for their disorder. The target population will be primarily African American, low income women at high risk for HIV/AIDS. Primary outcome measures will be number of unprotected (vaginal or anal) episodes of penetrative intercourse and proportion of unprotected sex occasions within a 6-week follow-up period. It is hypothesized that the SSB+A group will demonstrate significantly lower rates of unprotected sex at follow-up compared with the HIV education group alone. If results prove promising, they will be used to estimate effect sizes for a subsequent full-scale, randomized clinical trial of SSB+A.