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

全国调查发现，怀孕期间使用毒品和相关的艾滋病毒风险是主要的公共健康问题。 问题（SAMHSA，2004年）。虽然药物治疗本身对与毒品有关的艾滋病毒具有强大的威慑力， 风险行为（例如，非无菌药物注射设备），较少关注性风险 行为，这是缓慢改变。这对孕妇来说尤其如此， 避孕套不再是预防怀孕的必要手段。降低性风险的一个有希望的策略 艾滋病毒和其他性病传播的“安全性行为技能建设”（SSB）计划， Bassel and Schilling（1991，1992）.这种人工驱动的、针对性别的干预措施已证明在以下方面是有效的： 减少美沙酮维持治疗和门诊无药患者的性风险行为。到目前为止， 然而，这种干预措施还没有在实际上可能处于怀孕期的吸毒妇女中进行过测试。 如果她们在怀孕期间停止使用避孕套或继续吸毒，风险会增加。拟定的研究将 在两个样本中检查SSB，一种有针对性的艾滋病毒预防和降低风险的干预措施， 吸毒的孕妇使用2x2设计，随机临床试验将比较五个疗程 SSB组干预为一次标准组艾滋病教育干预（SE）。增加 概括性地说，受试者将分为两组： 在里士满行为健康管理局（RBHA，N=280）接受治疗的患者和通过城市 产前保健诊所与高基础率的物质使用障碍（PCC，N=280）。研究参与者将 在基线以及随机化后1、3和6个月进行评估。成果衡量将侧重于 无保护的性活动以及与酒精/毒品有关的性行为。研究结果 将提供关于SSB在不同样本中预防艾滋病毒和性病的功效的基准数据， 吸毒的孕妇

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.