AIDS and Behavior

, Volume 7, Issue 3, pp 229–243 | Cite as

A Cognitive–Behavioral Intervention to Reduce HIV Risk Behaviors in Crack and Injection Drug Users

  • Scott L. Hershberger
  • Michele M. Wood
  • Dennis G. Fisher


This paper presents the results of a study evaluating the efficacy of a theory-based cognitive–behavioral intervention to reduce HIV risk among street-based crack and injection drug users not currently in drug treatment in Long Beach, California. A nine-session, 4-month enhanced intervention (including HIV counseling and testing) was compared to a two-session standard counseling and testing intervention developed by the National Institute on Drug Abuse (NIDA) in terms of their efficacy for reducing drug- and sex-related risk behaviors. The theory-based enhanced intervention rarely was found to be different from NIDA's standard counseling and testing intervention in reducing both drug- and sex-related risks, as indicated by cessation and/or reduction of drug use (measured by urine test and self-report), entry into drug treatment, and increased frequency of condom use. One of the few significant effects was that the enhanced intervention significantly increased injecting drug users' use of their own injection equipment. On the other hand, for both interventions, most risk behaviors were significantly reduced. It is concluded that the theory-based cognitive–behavioral intervention has limited advantage over the standard intervention in terms of both magnitude and frequency of HIV risk reduction achieved by high-risk, active drug users.

Drug abuse HIV prevention Evaluation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abdul-Quader, A. S., Tross, S., Friedman, R., Kouzi, A. C., and Des Jarlais, D. C. (1990). Street-recruited intravenous drug users and sexual risk reduction in New York City. AIDS, 4 1075–1079.Google Scholar
  2. Anglin, M. D., and Fisher, D. G. (1987). Survival analysis in drug program evaluation: Part II. Partitioning treatment effects. The International Journal of the Addictions, 22, 377–387.Google Scholar
  3. Booth, R. E., Watters, J. K., and Chitwood, D. D. (1993). HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. American Journal of Public Health, 83, 1144–1148.Google Scholar
  4. Broadhead, R. S., Kerr, T. H., Grund, J., Alice, and Altice, F. L. (2002). Safer injection facilities in North America: Their place in public policy and health initiatives. Journal of Drug Issues, 32, 329–352.Google Scholar
  5. Cagle, H. H., Fisher, D. G., Senter, T. P., Thurmond, R. D., and Kaster, A. J. (2002). Classifying skin lesions of injection drug users: A method for corroborating disease risk. Washington, DC: National Clearinghouse for Alcohol and Drug Information.Google Scholar
  6. Centers for Disease Control and Prevention. (2001). U.S. HIV and AIDS cases reported through June 2001. HIV/AIDS Surveillance Report, 13(1), 1–41.Google Scholar
  7. Chiasson, M. A., Stoneburner, R. L., Hildebrandt, D. S., Ewing, W. E., Telzak, E. E., and Jaffe, H. W. (1991). Heterosexual transmission of HIV-1 associated with the use of smokable freebase cocaine (crack). AIDS, 5, 1121–1126.Google Scholar
  8. Colón, H. M., Robles, R. R., Freeman, D., and Matos, T. D. (1993). Effects of a HIV risk reduction education program among injection drug users in Puerto Rico. Puerto Rico Health Sciences Journal, 12, 27–34.Google Scholar
  9. Cook, T. D., Gruder, C. L., Hennigan, K. M., and Flay, B. R. (1979). History of the sleeper effect: Some logical pitfalls in accepting the null hypothesis. Psychological Bulletin, 86, 662–679.Google Scholar
  10. Cottler, L. B., et al. (1998). Peer-delivered interventions using HIV risk behaviors among out-of-treatment drug abusers. Public Health Report, 113(Suppl. 1), 42–57.Google Scholar
  11. Coyle, S. (1993). The NIDA HIV counseling and education intervention model: Intervention manual (NIH Pub. No. 93–3508). Rockville, MD: National Institute on Drug Abuse.Google Scholar
  12. Coyle, S. L., Needle, R. H., and Normand, J. (1998). Outreach-based HIV prevention for injecting drug users: A review of published outcome data. Public Health Reports, 113, 19–30.Google Scholar
  13. Des Jarlais, D. C. (2000). Structural interventions to reduce HIV transmission among injecting drug users. AIDS, 14(Supplement 1), S41-S46.Google Scholar
  14. Des Jarlais, D. C., Perlis, T., Friedman, S. R., Chapman, T., Kwok, J., Rockwell, R., Paone, D., Milliken, J., and Monterroso, E. (2000). Behavioral risk reduction in declining HIV epidemic: Injection drug users in New York City, 1990–1997. American Journal of Public Health, 90, 1112–1116.Google Scholar
  15. Dowling-Guyer, S., Johnson, M. E., Fisher, D. G., Needle, R., Watters, J., Anderson, M., Williams, M., Kotranski, L., Booth, R., Rhodes, F., Weatherby, N., Estrada, A. L., Fleming, D., Deren, S., and Tortu, S. (1994). Reliability of drug users' self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment, 1, 383–392.Google Scholar
  16. Dushay, R. A., Singer, M., Weeks, M. R., Rohena, L., and Gruber, R. (2001). Lowering HIV risk among ethnic minority drug users: Comparing a culturally targeted intervention to a standard intervention. American Journal of Drug and Alcohol Abuse, 27(3), 501–524.Google Scholar
  17. Elwood, W. N., Williams, M. L., Bell, D. C., and Richard, A. J. (1997). Powerlessness and HIV prevention among people who trade sex for drugs (“strawberries”). AIDS Care 9, 273–284.Google Scholar
  18. Fisher, D., Needle, R., Weatherby, N., Brown, B., Booth, R., and Williams, M. (1993, June). Reliability of drug user self-report [Abstract]. In Abstracts of the IXth International Conference on AIDS, Berlin.Google Scholar
  19. Friedman, L. M., Furberg, C. D., and DeMets, D. L. (1996). Fundamentals of clinical trials, 3rd ed. St. Louis, MO: Mosby.Google Scholar
  20. Gibson, D. R., McCusker, J., and Chesney, M. (1998). Effectiveness of psychosocial interventions in preventing HIV risk behavior in injecting drug users. AIDS, 12(8), 919–929.Google Scholar
  21. Inciardi, J. A., and Needle, R. H. (1998). HIV/AIDS interventions for out-of-treatment drug users. Journal of Psychoactive Drugs, 30(3), 225–229.Google Scholar
  22. Johnson, M. E., Fisher, D. G., Fenaughty, A., and Cagle, H. H. (2002a). A brief cognitive–behavioral intervention for HIV prevention among injection drug users and cocaine smokers not in treatment. Journal of Articles in Support of the Null Hypothesis, 1(1), 15–21.Google Scholar
  23. Johnson, W. D., Hedges, L. V., Ramirez, G., Semaan, S., Norman, L. R., Sogolow, E., Sweat, M. D., and Diaz, R. M. (2002b). HIV prevention research for men who have sex with men: A systematic review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 30(Supplement 1), 118–131.Google Scholar
  24. Kotranski, L., Semaan, S., Collier, K., Lauby, J., Halbert, J., and Feighan, K. (1998). Effectiveness of an HIV risk reduction counseling intervention for out-of-treatment drug users. AIDS Education and Prevention, 10, 19–33.Google Scholar
  25. Maddux, J. E., and Rogers, R. W. (1983). Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. Journal of Experimental Social Psychology, 19, 469–479.Google Scholar
  26. McCoy, C. B., Rivers, J. E., and Khoury, E. L. (1993). An emerging public health model for reducing AIDS-related risk behaviors among injection drug users and their sexual partners. Drugs and Society, 7, 143–160.Google Scholar
  27. McCoy, H. V., McCoy, C. B., and Lai, S. (1998). Effectiveness of HIV interventions among women drug users. Women and Health, 27, 49–66.Google Scholar
  28. National Center for HIV, STD, and TB Prevention. (2002). Fact sheet: Drug associated HIV transmission continues in the United States, 11 March 2002. Retrieved 17 May 2002 from Scholar
  29. National Institute on Drug Abuse. (1993). Risk behavior assessment questionnaire. Rockville, MD: Author.Google Scholar
  30. National Institute on Drug Abuse. (1994). Risk behavior follow-up assessment questionnaire. Rockville, MD: Author.Google Scholar
  31. Needle, R., Weatherby, N., Chitwood, D., Booth, R., Watters, J., Fisher, D. G., Brown, B., Cesari, H., Williams, M. L., Andersen, M., and Braunstein, M. (1995). Reliability of self-reported HIV risk behaviors of drug users. Psychology of Addictive Behaviors, 9, 242–250.Google Scholar
  32. Neumann, M. S., Johnson, W. D., Semaan, S., Flores, S. A., Peersman, G., Hedges, L. V., and Sogolow, E. (2002). Review and meta-analysis of HIV prevention intervention research for heterosexual adult populations in the United States. Journal of Acquired Immune Deficiency Syndromes, 30(Supplement 1), 106–117.Google Scholar
  33. Nyamathi, A. M., Bennett, C., and Leake, B. (1995). Predictors of maintained high-risk behaviors among impoverished women. Public Health Reports, 110, 600–606.Google Scholar
  34. Prochaska, J. O., and DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395.Google Scholar
  35. Prochaska, J. O., and DiClemente, C. C. (1986). Toward a comprehensive model of change. In W. R. Miller and N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 3–27). New York: Plenum Press.Google Scholar
  36. Rhodes, F., and Humfleet, G. L. (1993). Using goal-oriented counseling and peer support to reduce HIV/AIDS risk among drug users not in treatment. Drugs and Society, 7, 185–204.Google Scholar
  37. Rhodes, F., and Malotte, C. K. (1996). HIV risk interventions for active drug users: Experience and prospects. In S. Oskamp and S. Thompson (Eds.), Understanding and preventing HIV risk behavior: Safer sex and drug use (pp. 207–236). Thousand Oaks, CA: Sage.Google Scholar
  38. Rosenstock, I. M., Strecher, V. J., and Becker, M. H. (1994). The health belief model and HIV risk behavior change. In R. J. DiClemente and J. L. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioral interventions (pp. 5–24). New York: Plenum Press.Google Scholar
  39. Seeman, S., Des Jarlais, D. C., Sogolow, E., Johnson, W. D., Hedges, L. V., Ramirez, G., Flores, S. A., Norman, L., Sweat, M. D., and Needle, R. (2002). A meta-analysis of the effect of HUIV prevention interventions on the sex behaviors of drug users in the United States. Journal of Acquired Immune Deficiency Syndromes, 30(Supplement 1), 73–93.Google Scholar
  40. Shadish, W. R., Cook, T. D., and Campbell, D. T. (2001). Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin.Google Scholar
  41. Siegal, H. A., Falck, R. S., Carlson, R. G., and Wang, J. (1995). Reducing HIV needle risk behaviors among injection-drug users in the Midwest: An evaluation of the efficacy of standard and enhanced interventions. AIDS Education and Prevention, 7, 308–319.Google Scholar
  42. Simpson, D. D., Camacho, L. M., Vogtsberger, K. N., Williams, M. L., Stephens, R. C., Jones, A., and Watson, D. D. (1994). Reducing AIDS risks through community outreach interventions for drug injectors. Psychology of Additive Behaviors, 8, 86–101.Google Scholar
  43. Stephens, R. C., Simpson, D. D., Coyle, S. L., and McCoy, C. B. (1993). Comparative effectiveness of NADR interventions. In B. S. Brown and G. M. Beschner (Eds.), Handbook on risk of AIDS: Injection drug users and sexual partners (pp. 519–556). Westport, CT: Greenwood.Google Scholar
  44. Weatherby, N. L., Needle, R., Cesari, H., Booth, R., McCoy, C. B., Watters, J. K., Williams, M., and Chitwood, D. D. (1994). Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Evaluation and Program Planning, 17, 347–355.Google Scholar
  45. Wingood, G. M., and DiClemente, R. J. (1998). Wingood and DiClemente respond: Unanswered questions remain [Letter]. American Journal of Public Health 88, 1268.Google Scholar
  46. Wolitski, R. J., MacGowan, R. J., Higgins, D. L., and Jorgensen, C. M. (1997). The effects of HIV counseling and testing on risk-related practices and help-seeking behavior. AIDS Education and Prevention, 9, 52–67.Google Scholar
  47. Wong, M. L. (1995). Behavioral interventions in the control of human immunodeficiency virus and other sexually transmitted diseases—A review. Annals of the Academy of Medicine, Singapore, 24, 602–607.Google Scholar
  48. Wood, M. M., and Rhodes, F. (1996). Using social gatherings to encourage HIV risk reduction among drug users. American Journal of Public Health, 86, 1815–1816.Google Scholar
  49. Wood, M. M., Tortu, S., Rhodes, F., and Deren, S. (1998). Differences in condom behaviors and beliefs among female drug users recruited from two cities. Women and Health, 27, 137–160.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Scott L. Hershberger
    • 1
  • Michele M. Wood
    • 1
  • Dennis G. Fisher
    • 1
  1. 1.Department of Psychology, Center for Behavioral Research and ServicesCalifornia State University, Long BeachLong Beach

Personalised recommendations