Modifying Safer Sex Skill Building (SSB) to Prevent HIV in Alcohol Abusing Women

描述（由申请人提供）：酒精和药物依赖妇女的生活方式往往使她们在心理和医疗后遗症的风险增加。艾滋病毒/性病感染也不例外。虽然已发现参与药物滥用治疗可有效减少药物使用，但迄今为止的研究表明，在减少危险性行为方面的成功率相对较低。相反，据报告，社会文化和背景因素是使用避孕套和性谈判的障碍。一个有希望的方法是“安全性行为技能建设”（SSB），这是Schilling及其同事（1991年）进行的5次人工干预。随机分配到SSB的妇女报告说，与接受标准艾滋病毒教育的妇女相比，安全套使用和其他安全性行为增加。然而，SSB干预措施主要是为有一种或多种非法药物问题的妇女制定的。对酒精使用障碍及其对高危性行为的影响的关注要少得多，而高危性行为更为普遍。这一B-START建议旨在进一步加强SSB课程，在现有单元（SSB+A）中增加“酒精风险意识”和“酒精使用背景”部分，使妇女能够创建一个导致危险性行为的酒精和药物使用模式以及发生这种行为的社会和关系环境的马赛克。使用Rounsaville等人（2001年）的行为疗法研究阶段模型，该B-START应用程序将：a）在患有酒精使用障碍的育龄妇女样本中开发并初步测试SS B +A; B）根据参与者和专家小组的反馈修订SS B +A干预措施; c）进行一项小型随机临床试验，将SS B +A与一次标准HIV教育组进行比较。受试者将是因其疾病而入组住院治疗的酗酒或依赖性育龄女性。目标人群将主要是非洲裔美国人、艾滋病毒/艾滋病高危低收入妇女。主要结局指标为6周随访期内无保护（阴道或肛门）插入性交次数和无保护性行为的比例。据推测，SSB+A组将显示出显着较低的比率，在后续的无保护性行为相比，单独的艾滋病毒教育组。如果结果被证明是有希望的，它们将用于估计后续SSB+A的全规模随机临床试验的效应量。

DESCRIPTION (provided by applicant): The lifestyle of alcohol and drug dependent women often places them at increased risk for psychological and medical sequelae. HIV/STD infection is no exception. While participation in substance abuse treatment has been found to be effective in reducing drug use, research to date has demonstrated a relatively low success rate with regard to reducing sexual risk behaviors. Rather, socio-cultural and contextual factors have been reported as barriers to condom use and sexual negotiation. One promising approach, is "Safer Sex Skill Building" (SSB), a 5-session, manual-driven intervention by Schilling and colleagues (1991). Women randomly assigned to SSB reported increased condom use and other safe sex practices compared to women receiving standard HIV education. The SSB intervention, however, was developed primarily for women with one or more illicit drug problems. Much less attention was given to alcohol use disorders and their contribution to high risk sexual behaviors, which are more prevalent. This B-START proposal seeks to further enhance the SSB curriculum by adding "alcohol risk awareness" and "alcohol use context" components to existing modules (SSB+A), enabling women to create a mosaic of the pattern of alcohol and drug use that leads to risky sexual behavior and the social and relationship environment in which this occurs. Using the Rounsaville et al (2001) Stage Model of Behavioral Therapies Research, this B-START application will: a) develop and pilot test SSB+A in a sample of women of childbearing age with alcohol use disorders; b) revise the SSB+A intervention with both participant and expert panel feedback; and c) conduct a small randomized clinical trial comparing SSB+A to a one session standard HIV education group. Subjects will be alcohol abusing or dependent women of childbearing age who are enrolled in residential treatment for their disorder. The target population will be primarily African American, low income women at high risk for HIV/AIDS. Primary outcome measures will be number of unprotected (vaginal or anal) episodes of penetrative intercourse and proportion of unprotected sex occasions within a 6-week follow-up period. It is hypothesized that the SSB+A group will demonstrate significantly lower rates of unprotected sex at follow-up compared with the HIV education group alone. If results prove promising, they will be used to estimate effect sizes for a subsequent full-scale, randomized clinical trial of SSB+A.