Drug users participating in a treatment program based on a “therapeutic
community” model showed a decrease in HIV-related high risk behavior, according
to a new study by University of California, San Francisco AIDS researchers.

The study found that program participants made positive behavior changes in
both drug injection use and high-risk sex.

One of the most notable findings was the correlation between length of time
associated with treatment and decision-making regarding high-risk activity,
said William J. Woods, PhD, study co-investigator and a research psychologist
with the UCSF Center for AIDS Prevention Studies.

“We found that the longer the period of time spent in the treatment program,
the less likelihood that a person would engage in the very high-risk behavior
of needle sharing.  We also saw this pattern in regard to high-risk sex , but
it was not as significant as the correlation with high-risk drug activity,”
Woods said.

Research results are reported in the November issue of the journal AIDS.  The
study involved 261 clients in a drug treatment program at Walden House in San

In the therapeutic community model, program staff members act as a surrogate
family to help clients abolish behaviors related to drug use, develop
self-esteem, and develop self-reliance, according to Woods.  Treatment involves
a variety of clinical and support services, such as individual, group, and
family counseling, education and vocational services, and social and
recreational activities.  Treatment is structured to move participants from
drug dependence to a drug-free lifestyle.

Study participants were assigned either to the day program, in which they
returned to their homes each day, or to the residential program, with
24-hour-a-day structure.  Participants included both men and women, ranging in
age from 18 to 53 years.  The primary drug of choice was cocaine for 67 percent
of participants and heroin for 13 percent.

From the early days of the AIDS epidemic, injection drug users (IDUs) were
identified as a group at risk for HIV infection through the sharing of needles
and other drug paraphernalia, with later studies showing that IDUs and their
sexual partners also were at increased risk of HIV through sexual behaviors,
Woods noted.  As the epidemic continued, it became known that substance abusers
who did not inject drugs also were at greater risk of HIV infection than the
general population because of high-risk sexual practices.

“Now recent evaluations have concluded that methadone maintenance programs
reduce needle use among drug users, but the evidence has been less clear about
the value of other treatment modalities in reducing HIV risk among both IDUs
and non-IDUs.  So our objective was to measure this value,” Woods said.

Study participants were interviewed about high-risk behaviors at the beginning
of the treatment program and then at 6, 12, and 18 months.

## Among the study findings:

* Participants in treatment for at least 6 months were less likely to shoot up
drugs with other people or use other people’s syringes or needles.
* The longer a participant was in treatment, the less likelihood he or she
would use a needle exchange program. “The reason for this finding is not clear,
although it may be related to the program’s emphasis on abstinence. Those
attempting to remain abstinent may not plan ahead when they do use, which would
be required if a person was to use a needle exchange program,” Woods said.
* Positive changes in sexual behavior among participants included a decrease in
the number of different sexual partners and an increase in those having a
regular partner.
* The number of participants who had undergone HIV testing or expressed
interest in future testing increased with each followup interview, suggesting
that “the usefulness of testing in the treatment setting is an issue for
non-IDUs as well for IDUs,” Woods said.
* There was no major difference in the effectiveness of the type of treatment
program-day or residential-in changing high-risk behavior. 

Joseph R. Guydish, PhD, associate professor with the UCSF Institute for Health
Policy Studies, was study principal investigator.  Co-investigators included
James L. Sorensen, PhD, Department of Psychiatry at UCSF and San Francisco
General Hospital Medical Center; Adam Coutts, BA, UCSF Department of Medicine;
Alan Bostrom, PhD, UCSF Department of Social and Behavioral Sciences; and
Alfonso Acampora, MBA, Walden House, Inc.

The research was supported by a grant from the National Institute on Drug