Multi-level HIV Prevention for Pregnant Drug Abusers

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DESCRIPTION (provided by applicant): The proposed study, targeting Pregnant Drug Abusers in treatment, is a randomized trial of Enhanced- Behavioral Skills Training (E-BST) compared to a time- and attention-matched Health Promotion Comparison (HPC) condition. E-BST is an adaptation of the original BST intervention (Eldridge, St. Lawrence et al. 1997), designed to strengthen relationship-based social competency skills of the original BST were crucial in sustaining adherence to protective behavior. The E-BST emphasizes negotiation/communication skills with sexual partners/significant others and social ecological skills of help- seeking and service utilization. Such ecological enhancements at multiple interactive levels-pointed to in the original BST trial as potentially facilitative of refusal skills-may provide continued reinforcement of behavioral change even after the intervention has ended. BST is one of the only effective behavioral interventions for women in drug treatment; however, only modest, short-term gains were demonstrated. Growing evidence indicates that impacts will continue to be minimal until interventions go beyond the individual to address contextual factors that can empower women in their actual life situations and address the difficulty of adopting and sustaining protective behavior. Participants will be 320 culturally diverse (30% Hispanic, 60% African American) pregnant drug abusers in treatment with random assignment to the E-BST and HPC. We will use HIM to explore how intervention effects are mediated by theoretically relevant Individual Cognitive-Behavioral (e.g., Information-Motivation-Behavior; Fisher and Fisher, 1992) and Contextual (e.g., Drug Abuse, Service and Social Support Utilization) factors and moderated by key background factors: cognitive functioning and traumatic abuse history. The proposed project responds to the NIH priority on translational research to adapt effective research-based intervention strategies to "real world" conditions. If successful, this research will offer a realizable HIV intervention strategy, bridging research and practice, that can be implemented for pregnant drug abusers within their communities.