and (5) prior to counseling, the administration of a structured interview schedule. In addition, 18 sites developed "enhanced" interventions involving didactic training sessions and other additional initiatives, including: (1) individual and group counseling on behavior change strategies; (2) couples counseling; (3) cognitive skills training; (4) peer networks; and (5) social skills training. As described in Chapter 3, it is apparent that these outreach programs are multicomponent AIDS prevention programs that do not rely exclusively on distributing bleach bottles in their attempt to reduce HIV risk behaviors and the transmission of HIV infection.

The NADR report (National Institute on Drug Abuse, 1994) indicates that these 28 sites assessed 33,407 injection drug users at intake. However, only those participants whose initial and follow-up data could be linked (13,475) formed the basis of the program evaluation component of this project. As such, these data represent a fraction of the total number of injection drug users who were served (or at least assessed) by the NADR projects (a 40 percent follow-up rate). For sex partners, 6,216 were assessed and 1,637 (26 percent) were followed.1 As reflected by the substantial variation in follow-up rates2 across sites, the quality of data provided by individual sites varied considerably. Given the considerable potential problems associated with attempting to integrate these data, the following section summarizes the evaluation results of one specific NADR site that has provided detailed information on program delivery and comprehensive longitudinal data on meaningful outcome measures (risk behaviors and HIV seroconversion).

The Chicago Experience

Chicago's NADR program (which is now supported by local funding) collected longitudinal data over a 4-year period in an attempt to assess program impact on risk behaviors and HIV seroconversion (Wiebel et al., 1993b, 1994). This program was similar to the other NADR sites in its focus on out-of-treatment injectors and use of street outreach workers as HIV prevention educators; however, it had unique elements as well. The project's prevention activities has six key features:

  1. The intervention is carried out by street outreach workers who are former injectors.

  2. Outreach staff identify and target social networks of injectors, rather than isolated individuals.

  3. Outreach staff educate network members about HIV and AIDS and work with them to realistically assess their own risks for HIV infection. Complete confidentiality is stressed throughout.

  4. Staff then offer multiple options for coping with identified risks.

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