We propose a randomized controlled trial (RCT) of the Skin intervention, compared to an assessment-only condition (both groups receive rapid HIV testing, a review of testing results, and brief HIV prevention counseling) among 350 injection drug users recruited during an acute medical hospitalization at Boston Medical Center. In the general hospital setting, injection drug users who otherwise might not seek care are accessible and teachable, and the presence of a drug-related illness can set the stage for patients to be more receptive to interventions2. We hypothesize that the Skin intervention will produce better outcomes at 1-, 3-, 6-, 9-, and 12-month(s) post-intervention.

Inclusion Criteria:

• 18 years of age or older
• report injection of heroin, cocaine, or methamphetamine (meth) on at least three different days in the week prior to admission
• have injected heroin, cocaine, or meth for at least three months
• positive urine screen for heroin, cocaine, or meth

Exclusion Criteria:

• currently psychotic (e.g., responding to internal stimuli through observed hallucinations or delusions), homicidal or suicidal
• cannot provide informed consent
• not able to complete interviews in English (expected to exclude <5% of IDUs)
• in police custody, expecting incarceration
• unable to provide names and contact information for at least two verifiable locator persons who will know where to find them for retention/follow-up purposes
• plan to move out of the Boston area in the next 12 months.