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

描述（由申请人提供）：依赖酒精和药物的妇女的生活方式往往使她们面临更大的心理和医学后遗症风险。艾滋病毒/性病感染也不例外。虽然已发现参加药物滥用治疗对减少药物使用有效，但迄今为止的研究表明，在减少性危险行为方面成功率相对较低。相反，据报道，社会文化和背景因素是避孕套使用和性谈判的障碍。一种很有前景的方法是“安全性行为技能建设”（SSB），这是Schilling和他的同事（1991）提出的5期人工干预。随机分配到SSB组的妇女报告说，与接受标准艾滋病毒教育的妇女相比，避孕套的使用和其他安全性行为增加了。然而，SSB的干预措施主要是针对有一种或多种非法药物问题的妇女。对酒精使用障碍及其对更普遍的高风险性行为的影响的关注要少得多。这项B-START提案旨在通过在现有模块（SSB+A）中增加“酒精风险意识”和“酒精使用背景”内容，进一步加强SSB课程，使妇女能够对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进行综合分析。使用Rounsaville等人（2001）的行为治疗研究阶段模型，这个B-START应用程序将：a)在有酒精使用障碍的育龄妇女样本中开发和试点测试SSB+ a；b)根据参与者和专家小组的反馈修改SSB+A干预措施；c)进行一项小型随机临床试验，将SSB+ a组与一次标准艾滋病毒教育组进行比较。研究对象为酗酒或依赖他人的育龄妇女，她们因自身障碍而接受住院治疗。目标人群将主要是非裔美国人、艾滋病毒/艾滋病高风险的低收入妇女。主要结果测量将是6周随访期内无保护（阴道或肛门）插入性交次数和无保护的性行为的比例。假设SSB+A组在随访时的无保护性行为发生率明显低于单独接受艾滋病毒教育的组。如果结果被证明是有希望的，它们将被用于估计后续SSB+ a的全面随机临床试验的效应大小。

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.