Staying Safe: Training IDUs in Strategies to Avoid HIV and HCV Infection

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DESCRIPTION (provided by applicant): We propose to develop an innovative Staying Safe Intervention based on the strategies and practices of long term IDUs who have managed to remain uninfected not only with HIV but also with Hepatitis C (HCV). This study will test the efficacy of such an intervention. In the USA alone, injection drug use accounts for 13% of new yearly HIV infections (CDC 2007). Worldwide, 12.6 million injection drug users internationally account for 10% of new HIV infections. Therefore, new approaches to reducing such infections are urgently needed. Our Staying Safe research team has developed research-based hypotheses about how to reduce infections using a novel design: The Positive Deviance Control-Case Life History method (Friedman et al. 2008). Staying Safe research studied how a minority of long-term IDUs in New York City develop strategies to remain uninfected not only with HIV but also with Hepatitis C (HCV). Based on these findings, we propose an exploratory R21 to develop a curriculum for teaching IDUs how to develop and implement long-term strategies to avoid high-risk contexts (e.g. shooting galleries) and circumstances of risk (e.g. heroin withdrawal) as well as how to avoid risk behaviors should they nonetheless find themselves in high-risk contexts or circumstances (e.g. carrying clean needles to shooting galleries). The specific aims of this proposal are to (1) develop a Staying Safe intervention curriculum with two main objectives: enhancing IDUs' capabilities to prevent injection or sexual HIV and HCV infection (if HIV and/or HCV negative) or injection or sexual transmission of HIV and/or HCV to others (if infected) and (2) pilot test an intervention based on the newly developed Staying Safe Curriculum, examining its acceptability, feasibility, and safety, and gathering preliminary evidence of the intervention's efficacy. Guided by social learning theory (Bandura, 1986) the Staying Safe Intervention will target the following self- change mechanisms: increase information about and awareness of risk environments, circumstances, and behaviors; teach new generative capabilities that have emerged directly from our preliminary studies; that is, skills, such as planning and problem solving to reduce risk; attend to the role of social networks in risk reduction practices and maintenance of behavior change; and increase motivation for implementing new long term preventive practices and strategies through the development of realistic long term preventive goals, and enhancing self efficacy for behavior change. PUBLIC HEALTH RELEVANCE: Statement Injection drug use continues to be a major risk factor for HIV and HCV infections worldwide. New approaches to reducing such infections are needed. We propose to develop a new Staying Safe Intervention based on the strategies and practices of long term IDUs who have managed to remain uninfected not only with HIV but also with Hepatitis C (HCV). This study will test the efficacy of such an intervention.