The proposed randomized controlled study will attempt to reduce HIV sexual transmission risk and substance use, increase the utilization of primary HIV care services, and improve psychosocial health among a sample of 320 alcohol abusing, HIV+ individuals. The experimental intervention will include an adaptation of the Holistic Health Recovery Program (HHRP; Margolin et al., 2003) that is the only evidence-based, HIV+ intervention for improving sexual risk and adherence outcomes for an addicted population. For this study, the intervention will be adapted for use in a culturally diverse, alcohol abusing sample. HHRP will be compared to a Health Promotion Comparison (HPC) condition, which addresses common health problems, including personal hygiene and healthy living. Specific aims include: 1) comparing the adapted HHRP to the HPC condition to evaluate if HHRP reduces HIV sexual transmission risk, alcohol and other drug use, and improves the utilization of primary HIV care services and psychosocial health; 2) evaluating how Information, Motivation, Behavioral Skills mediate intervention effects on safe sex outcome; and 3) evaluating how key neuropsychological and molecular-genetic factors moderate the effect of the intervention on HIV transmission risk outcomes. Recruitment sites are primarily located in densely populated, multicultural, low income, urban areas of Miami with high rates of AOD abuse, HIV, violence and poverty, with the vast majority of the population being uninsured and suffering from multiple health disparities. The study is a prospective, randomized by cohort two-group design. The scheduled sequence of procedures will be: a) informed consent, screening, and baseline assessment; b) a 120 minute group session of HHRP or HPC sessions administered once a week for 12 consecutive weeks; and c) a post- intervention assessment. Follow-up assessment protocols will be administered at 3, 6, and 12 months post-intervention. Neuropsychological and blood tests for molecular/genetic typing will also be conducted to assist in identifying factors which may influence the impact of the intervention study. The proposed study will attempt to reduce HIV sexual transmission risk and substance use among a sample of alcohol abusing, HIV+ individuals. In studying the memory, information processing, executive functioning as well as genetic factors of the individuals of this study, researchers will be better able to discern those factors which may have an impact on treatment effects. This study therefore has the potential to identify individual characteristics that may contribute to specific reductions in risky behaviors in this sample.
