Community Supported Risk Reduction for Syringe Exchange Participants
Condition: Substance Use Disorders; Risk Reduction
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      Efforts to help syringe exchange registrants employ additional HIV risk reduction strategies
      are often thwarted by strong social networks that reinforce substance use and other risky
      injection use and sexual behaviors. The proposed study addresses this important problem by
      evaluating the feasibility and efficacy of a novel Community Supported Risk Reduction group.
      This structured intervention works with injection drug users and at least one drug-free
      family or friend to mobilize social support, teach HIV risk reduction skills, develop
      treatment readiness, and support participation in community activities designed to expand
      drug-free social networks.
    

Detailed description: 
      Participants of syringe exchange programs routinely suffer from untreated or under-treated
      substance use disorder, a situation that is associated with significant individual and public
      health costs. These individuals are also routinely embedded within social networks that
      reinforce continued drug use and related HIV-risk behaviors. The welfare of these individuals
      and the public's health can be improved by interventions directed toward reducing drug use
      risks and expanding drug-free support . Previous work by the investigators has demonstrated
      that an intervention combining an HIV risk reduction/treatment readiness group with
      behavioral contingencies is highly associated with increased rates of treatment enrollment
      and re-engagement, and reduced rates of drug use and HIV-injection risks, for up to one year.
      This protocol extends this work by adding a new component to the HIV risk reduction/treatment
      readiness group designed to expand social support and facilitate social network change. This
      intervention requires syringe exchange registrants to attend the group with a drug-free
      family or friend from their personal network that can provide stable support and encourage
      harm reduction and treatment seeking. This intervention uses an alteration network change
      model and posits that repeated exposure to drug-free community support collaterally reduces
      exposure to network members that support risk behaviors. This model also provides a pathway
      to modifying existing social networks by facilitating interaction with the personal social
      networks of drug-free family and friends. The intervention is supported by research showing
      that substance users report substantial pockets of drug-free family or friends in their
      social networks. It is also supported by community reinforcement principles that have shown
      efficacy in treatment samples, but have not been applied to out-of-treatment drug users. The
      present study has four primary aims. The first is to characterize natural drug-free support
      in the social networks of syringe exchangers. The second is to develop a Community Supported
      Risk Reduction group for syringe exchange participants and their community support. This
      group teaches skills for HIV risk reduction, treatment seeking, and healthy network
      expansion. The third and fourth aims are to obtain new data on the feasibility and efficacy
      of this intervention. Primary outcomes include changes in: 1) perceived social support, and
      2) HIV risk behaviors.
    

Intervention name(s): Risk Reduction Group
Intervention type(s): Behavioral
Intervention description(s): The Risk Reduction and Treatment Readiness skills component includes six modules: 1) BNEP services and substance abuse treatment; 2) nature of chemical dependence (severity/chronicity and medical aspects); 3) infectious diseases (HIV and Hepatitis C virus (HCV) information); 4) injection drug use risk reduction (effective equipment cleaning and drug-splitting techniques); 5) sex risk reduction (reducing high-risk behaviors and effective condom use); and 6) overdose prevention.
The Community Outreach skills component is devoted to discussing the benefits of recovery-focused social support, and directing BNEP registrants and their CSPs to participate in activities together (as determined in the group session) at least 1 time per week to work toward expanding the scope of drug-free social support.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Syringe exchange; HIV risk reduction; Drug-free community support