***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To evaluate the effectiveness of relapse prevention ( RP ) and brief intervention ( BI ) in reducing HIV risk-taking behaviours among injecting drug users ( IDU ) enrolled in methadone programmes . The hypotheses tested were : ( 1 ) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition ( C ) ; and ( 2 ) that Bl would be more effective in reducing HIV risk-taking behaviours than C. Design Clients of methadone programmes were r and omly assigned to either RP , Bl , or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects ' group allocations . Setting Confidential assessment interviews and interventions generally took place at the methadone unit treating the subject . Participants Ninety-five IDU enrolled in methadone programmes . Study entry criteria were : injection of any drug in the 6 months before the day of pre-intervention assessment ; literacy in English ; agreement to HIV-antibody testing for research purpose s ; and no known diagnosis of a serious mental illness . Eighty subjects were contacted successfully for a 6-month follow-up . Interventions The RP intervention was a six-session programme . Each 60–90-min session was conducted individually . The Bl was a one-session motivational interview lasting 60–90 min , accompanied by a self-help booklet . Main outcome measures All subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up . At follow-up , the Highest HIV Risk-Taking Behaviour Scale , collateral reports from subjects ' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected . Results Compliance with interventions was good . Correspondence of self-reports with urinalysis and collateral reports was satisfactory . There were no significant differences between groups in risk-taking behaviours during the month before follow-up . However , there was evidence of a lower rate of needle-risk behaviour ( sharing and cleaning ) during the heaviest risk-taking month since pre-intervention assessment in the group given RP . There were no indications that Bl was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour . Conclusions The results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes , but further research is required to replicate this finding Contingency management ( CM ) rapidly reduces cocaine use , but its effects subside after treatment . Cognitive-behavioral therapy ( CBT ) produces reductions months after treatment . Combined , the 2 might be complementary . One hundred ninety-three cocaine-using methadone-maintained out patients were r and omly assigned to 12 weeks of group therapy ( CBT or a control condition ) and voucher availability ( CM contingent on cocaine-negative urine or noncontingent ) . Follow-ups occurred 3 , 6 , and 12 months posttreatment . Primary outcome was cocaine-negative urine ( urinalysis 3 times/week during treatment and once at each follow-up ) . During treatment , initial effects of CM were dampened by CBT . Posttreatment , there were signs of additive benefits , significant in 3- versus 12-month contrasts . Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment Active injection drug users ( IDUs ) who are also hazardous alcohol users are at particularly high risk for HIV transmission due to sharing of injection equipment . We recruited AUDIT-positive injectors from the Providence , RI needle exchange program for a r and omized clinical trial testing the effect of a brief motivational intervention ( MI ) on frequency of injection-related HIV risk behavior ( IRRB ) . HIV drug risk behavior was measured as the number of days on which subjects reported sharing works using the 30-day Timeline Followback Method . Overall , 109 subjects reported a mean reduction of IRRB days of 9.1 days from baseline to 6-month follow-up ( p < .001 ) . When compared to controls , there was a trend in reduction of IRRB days to zero at follow-up for MI subject ( OR = 2.1 ; 95 % CI = 0.9 - 4.5 ) , and strongly significant reductions in IRRB days across a range of alternative improvement thresholds . Results from this study demonstrate that MI reduces drug-related HIV risk behaviors among active IDUs . As a brief intervention , MI may be a useful adjunct to existing services intended to reduce harm Drug abusers with psychiatric comorbidity are at high risk for becoming exposed to HIV . To address this compelling public health issue , our r and omized HIV prevention study compares the effectiveness of the NIDA st and ard HIV testing and counseling protocol to a four session , peer-delivered , educational intervention for out-of-treatment cocaine users with and without antisocial personality disorder ( ASPD ) and major depression . Among the 966 out-of-treatment cocaine users who have completed the 3 month follow-up , all groups , regardless of assignment to st and ard vs. peer-delivered intervention or psychiatric status , improved significantly in : crack cocaine use , injection drug use , number of IDU sex partners and overall number of sex partners , but not in condom use . Nevertheless , when stratified by psychiatric status , ASPD was associated with significantly less improvement in crack cocaine use ( P = 0.04 ) and with a trend for less improvement in having multiple sex partners and having IDU sex partners ( P = 0.06 and 0.08 , respectively ) . ASPD status was not associated with change in injection drug use or condom use . Depression was associated with a trend ( P = 0.07 ) for greater improvement in crack cocaine use but not in any of the other behaviors . When examining the st and ard and peer intervention groups separately , no consistent differences in the association of psychiatric comorbidity with outcome were discerned between the two groups . We conclude that persons with ASPD and depression respond well to st and ard HIV prevention interventions , but these psychiatric disorders respectively attenuate and enhance response somewhat . Behavioral interventions tailored for persons with these conditions may be indicated if long-term change in HIV risk behaviors is to be achieved This study examined and compared the effectiveness of two counseling interventions design ed to reduce the HIV drug and sexual risk behaviors of 684 out-of-treatment drug users recruited from South Philadelphia , PA . All study participants received a st and ard intervention and one half were r and omly assigned to also receive the enhanced intervention . The st and ard intervention provided  HIV risk reduction education , HIV testing with pretest and posttest counseling , and training in condom use and needle cleaning .  The enhanced intervention provided additional information on STD risk reduction . Both interventions were effective in influencing behavior change between baseline and 6-month follow-up . A higher proportion of persons reduced their drug risk behaviors compared to their sexual risk behaviors . As sexual risk behaviors are more resistant to change , there is a need for tailored interventions that target out-of-treatment drug users BACKGROUND Interventions are needed to assist drug abusers in reducing risky drug and sexual behavior . METHODS A r and omized controlled trial compared three small-group AIDS educational interventions among 567 clients of a 21-day inpatient drug detoxification program :  a two-session informational intervention , given either during the first ( early ) or second ( late ) week of treatment ; and a six-session enhanced intervention . Changes in knowledge , attitudes , and psychomotor skills were assessed before and after each intervention , and behavioral outcomes were assessed at follow-up 10 to 18 weeks after admission . RESULTS Immediately after the interventions , enhanced group members reported significantly greater self-efficacy to talk themselves out of AIDS-risky behavior ; other knowledge and attitude scales did not differ by intervention . At follow-up , significant reductions in risky drug use were reported by all groups . Enhanced group members reported significantly greater reduction in injection frequency than did late informational subjects . CONCLUSIONS No beneficial effect was detected of delaying AIDS education for clients entering detoxification . At this early stage of follow-up , there is only weak evidence that an enhanced intervention improved outcomes Methadone maintenance programs ( MMP ) have the potential to play an important role in reducing HIV risk , given the appropriate type and level of ancillary treatments . In this study , we investigated the efficacy of a 12-session harm reduction group intervention for injection drug users , based upon the Information-Motivation-Behavioral skills model of behavior change , that focused on reducing both drug and sex risk . Two hundred and twenty patients entering an MMP were r and omized to receive either st and ard care (SC)-2 hours of counseling per month and a single-session risk reduction intervention-or SC plus the harm reduction group ( HRG ) . Results showed that during treatment , patients receiving HRG were more likely to be abstinent from cocaine and to report fewer unsafe sexual practice s. Post-treatment , HRG patients scored higher on a sexual risk quiz and reported increased self-efficacy in high risk sexual situations . Enhancing methadone maintenance with a weekly harm reduction group treatment was somewhat more expensive but can bring about positive changes in behaviors and attitudes that are associated with the transmission of HIV A community-based HIV intervention for African-American women who are active injection drug users ( IDUs ) was evaluated . Seventy-one women ( aged 20–54 years ) were r and omly assigned to one of two enhanced gender- and culturally specific intervention conditions or to the NIDA st and ard condition . Substantial decreases ( p < .001 ) were found in the frequency of drug use and the frequency of drug injection as well as in the sharing of injection works or water and the number of injections . Trading sex for drugs or money , having sex while high , as well as other sexual risk behaviors were also reduced significantly . Furthermore , women in both enhanced intervention conditions were more likely to reduce their drug-using and sexual risk behaviors than were women in the st and ard condition . Results indicate the value of including additional components in interventions design ed to reduce the risk of infection with HIV among women who inject drugs BACKGROUND Injection drug users ( IDUs ) who also smoke crack may be at greatest risk for infection with HIV as well as other blood-borne and sexually transmitted infections and in most need of positive behavioral changes . METHODS Three hundred and thirty-three women ( aged 18 - 59 years ) were r and omly assigned to one of two enhanced gender- and culturally specific HIV intervention conditions or to the NIDA st and ard condition . Of primary interest in this study were baseline risk and intervention response rates among three groups of drug users -- IDUs who did not smoke crack , IDUs who did smoke crack , and crack smokers who did not inject . Univariate and multivariate methods were utilized , including generalized estimating equations . RESULTS The intervention produced positive behavioral changes over time , but response rates varied according to drug using group . Overall , women falling into the crack smoking IDU category appeared to be less responsive to the intervention than those in the other drug using groups , and participants in the crack smoking only group were less responsive than those in the IDU only group . CONCLUSIONS Results presented here indicate the continuing need to develop and target effective interventions to particular subgroups of high-risk individuals who may be most resistant to change OBJECTIVES Interventions to lower HIV risk behavior among drug users have concentrated on reduction of high risk injection practice s. Less attention has been directed to non-injecting drug users and drug-involved women . Female non-injecting drug users ( e.g. , women who abuse alcohol or crack cocaine ) are also at substantial risk for sexual transmission of HIV due to multiple partners , partners who self-inject and share needles , exchange of sex for drugs , coerced sex , high rates of sexually transmitted diseases , and low rates of condom use . This study compared the effectiveness of an educational intervention ( EC ) against the behavior skills training intervention ( BST ) in reducing sexual risk behavior among women ( N = 117 ) court-ordered into inpatient drug treatment . METHODS Participants were assessed at baseline , post intervention , and 2 months after discharge from the drug treatment facility . RESULTS Women in both conditions reported high rates of sexual risk behavior prior to the intervention . Women in both conditions had more positive attitudes toward HIV prevention and reported greater partner agreement with condom use at the post intervention assessment . However , these changes were not maintained at follow-up for women in the EC condition , whereas women in BST continued to show improvement post discharge . Women in the BST condition showed marked , while women in EC showed little improvement in communication skills and no improvement in condom application skill . At follow-up , women in both conditions had reduced drug use and drug-related high risk sex activities . BST women had increased their condom use while women in EC evidence d a decrease . Condom use increased from 35.7 % to 49.5 % of vaginal intercourse occasions for BST women and decreased from 28.8 % to 15.8 % for women in EC . CONCLUSIONS Results suggest a brief skills training intervention embedded in drug treatment programs can reduce sexual risk for HIV-infection after discharge The present study was an experimental test of efficacy of a brief education intervention for increasing HIV/AIDS knowledge among cocaine-dependent out patients . Participants were r and omly assigned to an HIV/AIDS education intervention ( experimental condition ) or a sham intervention ( control condition ) . Control participants were subsequently crossed over to the HIV/AIDS education intervention . Experimental participants had higher scores on tests of HIV/AIDS knowledge after receiving the education intervention than did control participants . Further supporting the intervention 's efficacy , control participant scores also increased once participants were crossed over and received the education intervention . Scores at follow-up were lower than at postintervention but remained higher than baseline scores . Results support 
    Output:
    
MAIN RESULTS There were minimal differences identified between multi-session psychosocial interventions and st and ard educational interventions for both injection and sexual risk behaviour .
Although it should be noted there were large pre-post changes for both groups suggesting both were effective in reducing risk behaviours .
In addition , there was some evidence of benefit for multi-session psychosocial interventions when compared with minimal controls .
Subgroup analyses suggest that people in formal treatment are likely to respond to multi-session psychosocial interventions .
It also appears single-gender groups may be associated with greater benefit .
There is limited support for the widespread use of formal multi-session psychosocial interventions for reducing injection and sexual risk behaviour .
Brief st and ard education interventions appear to be a more cost-effective option .