Program targets HIV+ injection drug users
Program targets HIV+ injection drug users
Study is designed with 10-week intervention
A large intervention program designed specifically for HIV-positive injection drug users (IDUs) may provide HIV programs with a workable way to teach this population about safety measures once the study concludes and outcomes data are available within the next two years.
"There have been no interventions for HIV-positive IDUs, and interventions with [other] seropositive HIV folks are relatively new," says David Purcell, JD, PhD, a behavioral scientist with the Centers for Disease Control and Prevention (CDC) in Atlanta. Purcell also is the team leader for the Behavioral Intervention Research Branch of the CDC and is the project officer for the Interventions for HIV-SeroPositive IDUs — Research and Evaluation (INSPIRE) project.
INSPIRE aims to help IDUs take a peer-oriented role through an intervention that might help them change their own behaviors and also encourage other IDUs to change their risk behaviors, Purcell says.
This is done through 10 intervention sessions, including seven individual sessions, two group sessions, and a community outreach session where participants work and participate in a community-based program or with an AIDS service organization, he adds.
The first four sessions of the intervention focus on adherence to HIV medications and access to medical care; the next four sessions address reducing sex and drug-use behaviors that might transmit HIV or lead to infection with sexually-transmitted disease; the ninth session has participants working two to four hours in an agency that serves HIV-positive IDUs, and the 10th session provides a reinforcement of the lessons of intervention, along with a graduation.
"The content is on helping people with primary things that concern HIV-positive IDUs, such as getting into care, utilizing care at the appropriate rate, adhering to medications if they’re on them, and working with the doctor to decide if they should be on medications, and reducing risk behavior and drug use," Purcell explains.
Based on previous prevention programs that have proven success, the program is designed to designate participants as peer mentors, although it’s an informal label that doesn’t mean they have passed any type of special training or certificate course.
This idea came out of research intervention projects that targeted gay and bisexual men by having researchers visit gay bars and ask clients to nominate the five most visible people in the community. These are the popular opinion leaders who are targeted to help change other people’s behavior, Purcell says. "What researchers found was that the peer opinion leaders also changed their own behavior, and that’s what we are going for," he explains.
"What we’re focusing on is content and activities between each session of talking to peers about their medical care and listening before you talk and not being opinionated about it," Purcell explains. "If you get folks together to talk about sex and drug risk behavior, that turns off people. We hook people into the program with statements like, Even though you’re not engaging in risk behavior, you know folks who are.’"
The study includes a control group that receives eight sessions on prevention, led by two group leaders. These sessions include videos and discussions about substance use, disclosure of HIV status to children, prejudice, and other relevant topics. At baseline, the study enrolled about 1,500 people in four cities, and there will be about 1,000 who will go through the intervention and control group. Each participant is followed at three months, six months, and 12 months.
The five-year intervention study, which began in late 1999, involves Johns Hopkins University in Baltimore; the University of Miami in Miami; the New York Academy of Medicine in New York City; and the University of California-San Francisco. About 80% of the participants have been African-Americans, Hispanics, and other people of color. The median age is about 40 years, and there are more men than women participants.
One of the drawbacks of the intervention study is that because it involves a lengthy follow-up of participants and is for research purposes, participants are being paid for their time, and this sort of incentive would not be practical if the intervention were used in a nonresearch, community setting. "For studies we have to do this," Purcell says. "It’s expected that you pay people for their time and effort, and so we do, and the people also like the program — they come for the money initially, but then they like it."
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