Mark Williams - US grants

DESCRIPTION (provided by applicant): This proposal is an investigator generated innovative research design consistent with the National Institute on Drug Abuse's request for applications, 94-054, "Strategies to Reduce HIV Sexual Risk Practices in Drug Users." The intersection of crack cocaine and high-risk sexual activity is a major factor propelling new HIV infections in the United States. Heterosexual African Americans who reside in concentrated urban areas are at especially high risk for HIV infection. The mechanisms of infection include increased numbers of sex partners, high rates of STDs, and sex for drugs or money exchanges. The purpose of this proposed study, A Test of a Peer Self-Efficacy Intervention, is to evaluate an HIV risk reduction intervention targeting African American crack cocaine smokers. The intervention will test the effect of a peer delivered self-efficacy intervention on condom use and condom use self-efficacy beliefs at the individual level. The intervention is derived from Bandura's Social Cognitive Theory. The Peer Self-Efficacy Intervention will be compared to a "standard care" HIV risk reduction intervention, the Peer NIDA Intervention. The sample for the study is not-in-treatment African American crack cocaine smokers residing in two targeted communities in Houston, Texas. The study is designed to specifically test the effects of peer interaction and intervention content on condom use behaviors and condom use self-efficacy beliefs. The design of the proposed study is a longitudinal cohort design. The design takes into account the reality of conducting research with not-in-treatment drug users. To examine the effects of the intervention on individual level condom use and self-efficacy beliefs, two matched neighborhoods will be randomly assigned to receive either the PSE Intervention or the comparison intervention. The comparison intervention is the "standard care" prevention model. In each neighborhood selected for the study, 200 crack cocaine smokers will be randomly selected from 600 crack smokers participating in a baseline study to take part in a longitudinal study. Participants in the longitudinal study will receive the intervention assigned to their community. Intervention activities will occur between months 1 and 3 of the behavioral study. Measurement of condom use and condom use self-efficacy beliefs outcomes will be at 6 and 12 months after baseline measurement. Outcomes of interest will be condom use, condom use self-efficacy beliefs, and the motivational and normative factors that have an impact on self-efficacy beliefs.

[unreadable] DESCRIPTION (provided by applicant): The research proposed here will focus on two critically important problems facing American society, the adverse personal and societal consequences of illicit drug abuse and the introduction, reintroduction, and spread of human pathogens. The study, Social Network Characteristics of a Highly Active HIV/STD Core Group, builds on our work on the characteristics, drug use, and HIV risk behaviors of male prostitutes and their sexual and drug using partners in Houston, Texas. Because of high levels of drug abuse, risky sexual activity and undiagnosed or untreated HIV/STDs, male prostitutes appear to play a significant role in periodically reintroducing sexually transmitted diseases into sexually active networks. Our research also indicates that male prostitutes travel frequently and widely, suggesting that these men may serve as 'vectors' for disease reintroduction into low prevalence, geographically disparate populations. In essence, male prostitutes may provide bridges between populations that otherwise are socially and/or geographically isolated in terms of the epidemiologically relevant links required to transmit pathogens. The principal aims of this study are to examine drug abuse in male prostitutes, properties of their drug use, sexual, and social networks, and the extent to which these are associated with the emergence and re- emergence of disease in previously unaffected populations. Secondly, the study aims to develop a protocol that will be used to study disease introduction and reintroduction in other groups involved in drug abuse. We propose to accomplish these aims by examining the characteristics of and change within a core network of drug using male prostitutes. The design of the study is a longitudinal network analysis. We will collect sociodemographic, drug use, sexual behavior, and personal network linkage data on participants who we believe may be embedded in larger networks, perhaps as high as 15,000 persons overall. We will initially sample the networks of 25 focal male prostitutes and their social, drug use, and sexual links and the drug use, sexual, and social links of the secondary networks. Whereas research to date has stressed personal networks, the 'building blocks' of larger social networks, our study will also collect data on structural patterns formed by the interconnection of personal networks into large social networks.

[unreadable] DESCRIPTION (provided by applicant): The study proposed in this application, Positive Choices Research Project builds on and continues work we began as part of a grant, "Condom use among drug users receiving antiretroviral medications, "R03 DA12318-01. The purpose of the Positive Choices Research Project is to evaluate the efficacy of a risk reduction protocol designed to reduce the sexual transmission of HIV by crack cocaine smokers receiving medical treatment for HIV disease. Specially, the purpose of the risk reduction protocol is to increase condom use during vaginal/anal intercourse. To evaluate the efficacy of the risk reduction protocol, we will implement a randomized clinical field trial. The trial will compare the Positive Choices risk reduction intervention to the current standard intervention for drug users in non-clinical settings. Bandura's Social Cognitive Theory (SCT) is the theoretical framework underpinning the Positive Choices intervention and the study design. The intervention methodology is cognitive mapping, a strategy that has been successfully used in drug treatment and is very compatible with SCT. Assessment of the effectiveness of the intervention will be based on data collected at completion of the intervention and at 3 and 9 months after completion of the intervention. This is the first study of which we are aware of that will investigate the efficacy of an intervention to increase condom use targeting HIV+ crack cocaine smokers. The Positive Choices Research Project has important scientific and pubic health implications. As the comparatively small number of studies in this areas shows, less than half of any sample of HIV positive (HIV+) drug users consistently use condoms. The psychosocial precursors that influence adoption of risk reduction practices may not be the same as those that influence maintenance of long-term behaviors. It is difficult to generalize from studies focusing on MSM. As a recent review of the literature concludes, heterosexual men are socialized to believe that only unprotected vaginal sex is sex. The Positive Choices Research Project will be tested in Houston, Texas. Houston is the nation's fourth largest city and has the sixth highest AIDS caseload. The city's caseload reflects the makeup of its population. Forty-five percent of cases are White, 38% African American, and 17% Hispanic. Seventeen percent of the caseload is female. Since 1994, more heterosexuals had been diagnosed with AIDS in Houston than any other group. The city has the unpleasant distinction of having the highest rate of new heterosexual infections in the United States. The epidemic among heterosexuals in Houston is focused in the African American community. About one-third of newly infected African Americans are women. The disease in the African American community is directly and indirectly linked to the crack cocaine epidemic. [unreadable] [unreadable]

The contribution made by injection drug use to the HIV/AIDS pandemic in sub-Saharan Africa has received little scientific attention. The "TANZANIAN AIDS PREVENTION PROJECT, (TAPP)," will investigate injection drug use in Sub-Saharan African. TAPP builds on research we have been conducting for the past two years in Dar es Salaam, Tanzania. Our studies strongly suggest that injection drug use may be a significant contributor to the AIDS pandemic in Africa, especially in urban areas. TAPP has six specific aims. They are: to describe the environmental barriers to and facilitators of safer needle use and sexual practices; to describe the nuances of needle sharing and sexual practices within dyad structures; to describe the effect of social stigma as a barrier to acceptability of HTV testing and educational activities; to estimate HTV prevalence among drug injectors in Dar es Salaam; to estimate the prevalence of safe/unsafe needle use and safe/unsafe sexual behaviors within dyad structures; and to estimate safer needle use and condom use intentions within dyad structures. We will accomplish these aims using a mixed method research design composed of qualitative and quantitative components. Data collection will be guided by the Social Cognitive Theory. Data will be collected from purposeful samples of injection drug users residing in seven neighborhoods in Dar es Salaam. The two components of the mixed design are complementary, each producing data that, when triangulated, will provide a rich assessment of the HTV injection drug risk environment, prevalence of HTV among injection drug users, and sufficient social cognitive data to guide the development of interventions to decrease HTV incidence related to injection drug use that are relevant to the Tanzanian context.

DESCRIPTION (provided by applicant): The purpose of this study, the Tanzanian Drug Treatment as HIV/AIDS Prevention Project (D-TAPP) - Reliability and Validity Study, is to conduct formative research necessary to the implement of drug treatment as an HIV prevention intervention in Dar es Salaam, Tanzania. The specific aims of D-TAPP 1) - Reliability and Validity Study are: Aim1: To develop culturally appropriate measures of psychological functioning, social functioning, treatment motivation, addiction severity, and readiness for treatment;Aim 2: To assess IDUs'understanding and relevancy of the measures of psychological functioning, social functioning, treatment motivation, addiction severity, and readiness for treatment;and Aim 3: To test the reliability and validity of the D-TAPP Questionnaire. The D-TAPP - Reliability and Validity Study will be implemented in three components reflecting the three specific aims using a mixed methods design. In component 1, the D-TAPP questionnaire will be translated from English to Swahili and the accuracy of the translations and the content validity of the translated measures will be assessed by a panel of native Swahili-speaking experts. In component 2, semi-structured interview data will be collected from a purposeful sample of 40 IDUs. In this component, the D-TAPP questionnaire will be presented to IDU participants, and they will be asked to assess the understandability and cultural relevancy of each item in the questionnaire (Aim 2). Participants will also be asked to evaluate scales used to record measurement responses. In particular, IDUs will be asked to make recommendations that will improve understandability, cultural relevancy, and response measurement. The questionnaire will be modified to reflect findings produced by the Component 2 study. Component 3 will assess the psychometrics of the measures. Internal and 48 hour test/retest reliability will be determined along with content, construct and criterion related validities. For this study, a purposeful sample of 150 IDUs will be recruited to participate. Data will be collected at intake and 48 hours later. PUBLIC HEALTH RELEVANCE: Tanzanian Drug Treatment as HIV/AIDS Prevention Project (D-TAPP) - Reliability and Validity Study will investigate the psychometric properties of standardized measures of treatment motivation in a sample of Tanzanian injection drug users.