Reducing drug use and HIV risk in drug-dependent adults arrested for prostitution

描述（由申请人提供）：使用注射毒品、吸食快克可卡因、拥有多个性伴侣和不一致使用避孕套的组合导致获得和传播艾滋病毒的巨大风险，许多因卖淫而被捕的吸毒成瘾成年人符合这一特征。现有的减少艾滋病毒风险的干预措施对吸毒成瘾的性工作者的效力有限，刑事司法办法尽管成本高，但效果不佳。一个潜在的理想替代方案是将毒品依赖者从起诉转向减少吸毒和艾滋病毒性风险行为的治疗，同时提供工作技能培训和促进社区就业，以减轻继续从事性工作的经济需要。为了提供一个有效的治疗替代刑事检控，我们建议制定一个多方面的干预，包括美沙酮治疗和治疗工作场所。治疗工作场所是一个得到支持的环境，要求参与者提供无毒品尿样，以获得有偿工作技能培训或就业，并保持最高工资率。总体干预措施旨在减少吸毒和艾滋病毒风险行为，同时促进就业。拟议的项目是一个为期两年的第一阶段行为疗法开发工作，其中将包括针对因卖淫而被捕的吸毒成瘾成年人的治疗性工作场所干预措施的开发、手册化和试点测试。在试点研究中，我们将从巴尔的摩东区地区法院招募因卖淫而被捕的阿片类药物和可卡因依赖成年人。合资格人士将获美沙酮治疗代替检控 并将被要求继续接受美沙酮治疗90天，以撤销对他们的指控。在登记接受美沙酮治疗后，被转介的人士会获邀参与先导研究。有兴趣的个人将被随机分配接受标准美沙酮治疗服务或这些服务加上治疗工作场所。治疗工作场所有两个阶段。在第一阶段，参与者将在治疗工作场所接受四个月的津贴支持职业培训。在第二阶段，参与者将被鼓励在社区工作，并将获得四个月的工资补贴，以维持社区就业或从事监督求职。在这两个阶段中，参与者将被要求提供无药物的尿液样本，以获得治疗工作场所的工资（第一阶段的培训津贴和第二阶段的工资补贴）。工资补贴计划将包括由全国无毒品工作场所服务供应商管理的药物测试。总的来说，这种治疗可以作为一种新的和理想的干预措施，为吸毒成瘾的成年人被捕卖淫，同时减少刑事司法成本。 公共卫生相关性：治疗工作场所是一种经证明有效的激励性干预措施，它利用例行药物测试和有条件获得津贴支持的职业培训和就业机会，以促进戒毒。我们建议开发，手册化和试点测试的治疗工作场所干预量身定制，以增加戒毒和减少艾滋病毒性行为的风险，在失业的阿片类药物和可卡因依赖的成年人被捕的卖淫谁是从审判转向治疗。治疗工作场所可以作为一种新颖和理想的干预措施，用于因卖淫而被捕的吸毒成瘾成年人，这可以增加禁欲和就业，并减少艾滋病毒风险和累犯。

DESCRIPTION (provided by applicant): The combination of using injection drugs, smoking crack cocaine, having multiple sex partners, and inconsistent condom use results in substantial risk for acquiring and transmitting HIV, and many drug dependent adults who have been arrested on charges of prostitution fit this profile. Existing interventions for reducing HIV risk have had limited efficacy in drug-dependent sex workers, and criminal justice approaches have been ineffective despite their high cost. A potentially ideal alternative is to divert drug-dependet arrestees from prosecution to a treatment that reduces drug use and HIV sex risk behaviors, while providing job skills training and promoting community employment to alleviate the financial need to continue sex work. In order to provide an effective therapeutic alternative to criminal prosecution, we propose to develop a multifaceted intervention that includes methadone treatment and the Therapeutic Workplace. The Therapeutic Workplace is a supported environment in which participants are required to provide drug-free urine samples to access paid job skills training or employment and to maintain the maximum rate of pay. The overall intervention is designed to reduce drug use and HIV risk behaviors, and simultaneously promote employment. The proposed project is a 2-year Stage I behavior therapy development effort that will include the development, manualization and pilot testing of a Therapeutic Workplace intervention tailored to drug- dependent adults arrested for prostitution. In the pilot study, we wll recruit opiate- and cocaine-dependent adults arrested for prostitution from the Eastside District Court in Baltimore. Eligible individuals will be offered methadone treatment in lieu of prosecution and will be required to remain in methadone treatment for 90 days to have the charges against them dropped. After enrolling in methadone treatment, the diverted individuals will be invited to participate in the pilot study. Interested individuals will be randomly assigned to receive the standard methadone treatment services or these services plus the Therapeutic Workplace. The Therapeutic Workplace has two phases. In Phase 1, participants will be offered four months of stipend-supported job training in the Therapeutic Workplace. In Phase 2, participants will be encouraged to seek employment in a community job and will receive wage subsidies for four months for maintaining community employment or engaging in supervised job seeking. Throughout both phases, participants will be required to provide drug-free urine samples to receive Therapeutic Workplace wages (training stipends in Phase 1 and wage subsidies in Phase 2). The wage subsidy program will include drug testing managed by a national supplier of drug-free workplace services. Overall, this treatment could serve as a novel and ideal intervention for drug-dependent adults arrested for prostitution while reducing criminal justice costs. PUBLIC HEALTH RELEVANCE: The Therapeutic Workplace is a motivational intervention of proven efficacy that uses routine drug testing and contingent access to stipend-supported job training and employment to promote drug abstinence. We propose to develop, manualize and pilot test a Therapeutic Workplace intervention tailored to increase drug abstinence and decrease HIV sex risk behaviors in unemployed opiate- and cocaine-dependent adults arrested for prostitution who are diverted from adjudication to treatment. The Therapeutic Workplace could serve as a novel and ideal intervention for diverted drug-dependent adults arrested for prostitution, which could increase abstinence and employment, and reduce HIV risk and recidivism.