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

描述（由申请人提供）：使用注射毒品、吸食快克可卡因、拥有多个性伴侣以及不一致使用安全套的组合导致感染和传播艾滋病毒的风险很大，许多因卖淫指控而被捕的依赖毒品的成年人都符合这一特征。现有的降低艾滋病毒风险的干预措施对依赖药物的性工作者的效果有限，刑事司法方法尽管成本很高，但效果并不好。一个潜在的理想替代方案是，将毒品依赖者从起诉转移到减少毒品使用和艾滋病毒性行为风险的治疗中，同时提供工作技能培训和促进社区就业，以减轻继续从事性工作的经济需求。为了提供一个有效的治疗替代刑事起诉，我们建议发展一个多方面的干预，包括美沙酮治疗和治疗工作场所。治疗工作场所是一个有支持的环境，要求参与者提供无毒品尿液样本，以获得有偿工作技能培训或就业，并保持最高工资水平。整体干预旨在减少吸毒和艾滋病毒风险行为，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治疗发展努力，将包括为因卖淫而被捕的依赖毒品的成年人量身定制的治疗场所干预的开发，手动化和试点测试。在试点研究中，我们将从巴尔的摩东区地方法院招募因卖淫而被捕的依赖鸦片和可卡因的成年人。符合条件的个人将提供美沙酮治疗代替起诉

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.