Reducing HIV: Safer sex skill building in pregnant, drug-abusing women

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National surveys have found drug use and associated HIV risk during pregnancy are major public health problems (SAMHSA, 2004). While drug treatment itself has been a powerful deterrent of drug-related HIV risk behaviors (e.g., non-sterile drug injection equipment), less attention has focused on sexual risk behaviors, which have been slower to change. This is particularly true for pregnant women, who are aware condoms are no longer necessary for pregnancy prevention. One promising strategy for reducing sexual risk for HIV and other STD transmission has been the "Safer Sex Skill Building" (SSB) program developed by El Bassel and Schilling (1991, 1992). This manual-driven, gender-specific intervention has proven effective in reducing sexual risk behaviors in both methadone maintenance and outpatient drug-free patients. To date, however, the intervention has not been tested with pregnant drug abusing women who may actually be at increased risk if they stop using condoms or continue drug use during pregnancy. The proposed study will examine SSB, a targeted behavioral HIV prevention and risk reduction intervention in two samples of pregnant drug abusing women. Using a 2x2 design, a randomized clinical trial will compare the five-session SSB group intervention to a one-session standard group HIV Education intervention (SE). To increase generalizability, subjects will be two groups of pregnant drug abusing women: those enrolled in formal drug treatment at Richmond Behavioral Health Authority (RBHA, N=280) and those identified through an urban prenatal care clinic with high base rates of substance use disorders (PCC, N=280). Study participants will be assessed at baseline as well as 1, 3 and 6 months post-randomization. Outcome measures will focus on occasions of unprotected sexual activity, as well as alcohol/drug related sexual episodes. Study findings will provide benchmark data on the efficacy of SSB for HIV and STD prevention in a diverse sample of pregnant drug abusing women.