Investigators at Washington University School of Medicine in St. Louis are launching several projects aimed at preventing the global spread of HIV infection by reducing high-risk behaviors in vulnerable populations, including women and youth. These projects build upon work that has been ongoing since 1989.
Researchers in the Department of Psychiatry’s Epidemiology and Prevention Research Group have received new grants and contracts totaling more than $3.2 million from the World AIDS Foundation, the National Institute on Drug Abuse (NIDA) and the National Institute of Nursing Research. Investigators will use the funding for a series of community-based projects aimed at assessing high-risk behavior in particular groups and intervening to reduce that risk. They also have received funding from NIDA to “deconstruct” a previous intervention to understand what parts of that intervention worked best.
Linda B. Cottler, Ph.D., professor of epidemiology in psychiatry and director of the Epidemiology and Prevention Research Group at the School of Medicine, is principal investigator of all the new projects.
In one, called the Sisters Teaching Options for Prevention project (STOP), Cottler’s team will provide peer-led interventions to inner city women in St. Louis who have been arrested for drug offenses. Because many women who use drugs also tend to engage in risky sexual behaviors or to engage in criminal behavior to support their drug use, the research team will work with the City Drug Court in St. Louis to tailor programs that help individual women reduce their risk behaviors and to help them comply with the recommendations made in their programs.
“We’ve had some success in the past with peer-led interventions among drug users,” Cottler says. “But we need to improve access to available services and to educate these women about the best ways to reduce high-risk behaviors and increase their knowledge about HIV and other sexually transmitted diseases.”
In India, Cottler’s group will work with the wives of men who engage in high-risk substance abuse and sex behaviors, including sex with prostitutes.
“Previous studies in HIV prevention have tended to target female commercial sex workers, but our study will look at women who are at risk because their husbands engage in risky behavior,” Cottler says. “It’s very important that we begin to give these women the tools they need to protect themselves, especially because India is considered to be an epicenter for HIV during the next decade.”
Cottler’s team also will study the use of club drugs — Ecstasy, ketamine, methampetamine and others — among young people in Taiwan. Ongoing research has suggested that young people who use these drugs tend to engage in many of the same risky behaviors as people who abuse more traditional, better studied drugs such as heroin or cocaine.
The club drug project will add information to Cottler’s other ongoing studies of club drug use among 15- to 30-year-olds in St. Louis, Miami and Sydney, Australia, in which volunteers recruited from high schools, colleges, rave parties, chemical dependency units and other areas are enrolled and asked about tobacco/alcohol use and dependence, as well as caffeine and other drug use. The researchers will ask young people in Taiwan the same questions, but the new study also will conduct positron emission tomography (PET) scans to evaluate brain function in users of club drugs to understand long-term consequences. Taiwan is an important area for study, because these types of drugs have been popular there for years.
All of the studies involve community-based programs that specifically target users out of treatment who may be at risk for HIV, sexually transmitted diseases, drug and alcohol dependence and other problems.
“We already know how to stop the spread of HIV, and we have programs to help people who abuse alcohol and drugs,” Cottler says. “But repeated boosters are needed to help people at risk adjust their behaviors. Few programs actually deal with these vulnerable populations. Our mission is public health research. Difficult as it might be, we feel it’s important to be in the community, working with these high risk populations to learn what really works.”
The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.