The overall aim of this study is to reduce risk behaviors and increase health and behavioral health service utilization among disadvantaged, drug-using rural women at high risk for HIV and HCV. This project has potential to make a significant contribution to science by providing knowledge about the health, risk behaviors, and service utilization of a vulnerable and understudied group of women during a time of emerging and significant public health risk in a rural Appalachian setting. Successful completion of the aims of this project will advance the delivery of a low-cost, potentially high impact intervention with implications for a number of other real world settings (such as criminal justice venues) where other disadvantaged high-risk drug users can be identified and targeted for intervention.

Specific Aim 1: Compare the effectiveness of an evidence-based HIV risk reduction intervention (MI-HIV) to HIV Education (NIDA Standard) in reducing sex risk behaviors, injection practices, and drug use among a culturally unique sample of disadvantaged, drug-using rural women at high-risk for HIV and HCV. This aim will be accomplished through the random selection of high-risk rural women drug users from rural jails, screening and assessment for high-risk behavior, and random assignment to the HIV-Ed or MI-HIV intervention conditions. Follow-up interviews at 3, 6, and 12 months in the community post-release will examine changes in high-risk behavior. It is expected that MI-HIV participants will report significantly greater reductions in risky injection drug use practices, other drug use, and sex risk behaviors than women who participate in the HIV-Ed condition.

Specific Aim 2: Examine MI-HIV Intervention engagement as a predictor of community health and behavioral health service utilization (including drug treatment and mental health) at follow-up among disadvantaged, drug-using rural women at high risk for HIV and HCV. This aim will focus on community service utilization during the follow-up period by the intervention and education comparison group, and how health and behavioral health service utilization relates to patterns of HIV/HCV risk behavior. It is expected that MI-HIV participants will utilize more services due to increased motivation for treatment and treatment planning following the brief intervention.

Inclusion Criteria:

• ASSIST score of 4+
• engagement in at least one sex risk behavior in the past 3 months
• willingness to participate in brief intervention sessions
• no evidence of cognitive impairment
• no evidence of active psychosis (currently experiencing hallucinations)
• no self-reported current symptoms of physical withdrawal from a recent episode of drug use
• incarceration period of 1 week - 3 months in order to complete intervention sessions

Exclusion Criteria:

• ASSIST score of <4
• no engagement in at least one sex risk behavior in the past 3 months
• not willing to participate in brief intervention sessions
• evidence of cognitive impairment
• evidence of active psychosis (currently experiencing hallucinations)
• self-reported current symptoms of physical withdrawal from a recent episode of drug use
• incarceration period of less than 1 week or greater than 3 months in order to complete intervention sessions

N/A, individual participant data will not be made available.

Adverse event data was collected for one year post-study enrollment.

The definitions of adverse events in this study do not differ from clinicaltrials.gov definitions.