Reducing drug use and HIV risk in drug-dependent adults arrested for prostitution

描述(申请人提供)：使用注射毒品、吸食强效可卡因、有多个性伴以及安全套使用不一致导致感染和传播艾滋病毒的重大风险，许多因卖淫指控而被捕的吸毒成年人符合这一描述。现有的降低艾滋病毒风险的干预措施对毒品依赖性工作者的效果有限，刑事司法方法尽管成本很高，但效果不佳。一个潜在的理想替代方案是将吸毒成瘾的被捕人员从起诉转移到减少吸毒和HIV性行为危险行为的治疗上，同时提供工作技能培训和促进社区就业，以减轻继续性工作的经济需求。为了提供一种替代刑事起诉的有效治疗方法，我们建议开发包括美沙酮治疗和治疗工作场所在内的多方面干预措施。治疗工作场所是一个得到支持的环境，参与者必须提供不含药物的尿样，才能获得有偿工作、技能培训或就业，并维持最高工资率。全面干预旨在减少吸毒和艾滋病毒危险行为，同时促进就业。拟议的项目是一项为期两年的第一阶段行为疗法开发工作，其中将包括为因卖淫被捕的药物依赖成年人量身定做的治疗工作场所干预措施的开发、手册制作和试点测试。在试点研究中，我们将招募因卖淫而被巴尔的摩东区法院逮捕的鸦片依赖和可卡因依赖的成年人。合资格人士将获提供美沙酮治疗，以代替检控 并将被要求接受美沙酮治疗90天才能撤销对他们的指控。在参加美沙酮治疗后，分流的个人将被邀请参加先导研究。感兴趣的个人将被随机分配接受标准美沙酮治疗服务或这些服务加上治疗工作场所。治疗工作场所有两个阶段。在第一阶段，参与者将在治疗工作场所接受为期四个月的津贴支持工作培训。在第二阶段，将鼓励参与者在社区寻找工作，并将获得为期四个月的工资补贴，用于维持社区就业或从事有监督的求职。在这两个阶段，参与者将被要求提供无毒尿样以获得治疗工作场所工资(第一阶段的培训津贴和第二阶段的工资补贴)。工资补贴计划将包括由一家全国性的无毒工作场所服务供应商管理的药物测试。总体而言，这种治疗可以作为一种新颖和理想的干预措施，帮助因卖淫而被捕的吸毒成年人，同时降低刑事司法成本。 公共卫生相关性：治疗工作场所是一种被证明有效的激励性干预措施，它利用常规药物测试和临时获得津贴支持的工作培训和就业机会来促进药物戒除。我们建议开发、手册和试点测试一种治疗性工作场所干预措施，该干预措施旨在增加因卖淫而被捕的失业阿片类和可卡因依赖型成年人的戒毒和减少艾滋病毒性行为的风险行为，这些成年人从裁决转向治疗。治疗工作场所可以作为一种新颖和理想的干预措施，用于因卖淫而被逮捕的吸毒成瘾成年人，这可以增加禁欲和就业，并降低艾滋病毒风险和再犯罪率。

DESCRIPTION (provided by applicant): The combination of using injection drugs, smoking crack cocaine, having multiple sex partners, and inconsistent condom use results in substantial risk for acquiring and transmitting HIV, and many drug dependent adults who have been arrested on charges of prostitution fit this profile. Existing interventions for reducing HIV risk have had limited efficacy in drug-dependent sex workers, and criminal justice approaches have been ineffective despite their high cost. A potentially ideal alternative is to divert drug-dependet arrestees from prosecution to a treatment that reduces drug use and HIV sex risk behaviors, while providing job skills training and promoting community employment to alleviate the financial need to continue sex work. In order to provide an effective therapeutic alternative to criminal prosecution, we propose to develop a multifaceted intervention that includes methadone treatment and the Therapeutic Workplace. The Therapeutic Workplace is a supported environment in which participants are required to provide drug-free urine samples to access paid job skills training or employment and to maintain the maximum rate of pay. The overall intervention is designed to reduce drug use and HIV risk behaviors, and simultaneously promote employment. The proposed project is a 2-year Stage I behavior therapy development effort that will include the development, manualization and pilot testing of a Therapeutic Workplace intervention tailored to drug- dependent adults arrested for prostitution. In the pilot study, we wll recruit opiate- and cocaine-dependent adults arrested for prostitution from the Eastside District Court in Baltimore. Eligible individuals will be offered methadone treatment in lieu of prosecution and will be required to remain in methadone treatment for 90 days to have the charges against them dropped. After enrolling in methadone treatment, the diverted individuals will be invited to participate in the pilot study. Interested individuals will be randomly assigned to receive the standard methadone treatment services or these services plus the Therapeutic Workplace. The Therapeutic Workplace has two phases. In Phase 1, participants will be offered four months of stipend-supported job training in the Therapeutic Workplace. In Phase 2, participants will be encouraged to seek employment in a community job and will receive wage subsidies for four months for maintaining community employment or engaging in supervised job seeking. Throughout both phases, participants will be required to provide drug-free urine samples to receive Therapeutic Workplace wages (training stipends in Phase 1 and wage subsidies in Phase 2). The wage subsidy program will include drug testing managed by a national supplier of drug-free workplace services. Overall, this treatment could serve as a novel and ideal intervention for drug-dependent adults arrested for prostitution while reducing criminal justice costs. PUBLIC HEALTH RELEVANCE: The Therapeutic Workplace is a motivational intervention of proven efficacy that uses routine drug testing and contingent access to stipend-supported job training and employment to promote drug abstinence. We propose to develop, manualize and pilot test a Therapeutic Workplace intervention tailored to increase drug abstinence and decrease HIV sex risk behaviors in unemployed opiate- and cocaine-dependent adults arrested for prostitution who are diverted from adjudication to treatment. The Therapeutic Workplace could serve as a novel and ideal intervention for diverted drug-dependent adults arrested for prostitution, which could increase abstinence and employment, and reduce HIV risk and recidivism.