Background. There is a strong association between crack/cocaine use and increased sexual risk behavior, but little research on the efficacy of HIV education for decreasing such behavior in crack/cocaine-addicted individuals in substance abuse treatment. Method. Datasets from two cocaine dependence trials including either one or three HIV education sessions, respectively, were analyzed for changes over time in the proportion of participants practicing safe sex. A pooled dataset from two earlier trials not offering HIV education was also analyzed. Results. We included 83 participants from the 1-session trial and 65 participants from the 3-session trial. Both sets of participants evidenced a significant increase in the proportion of participants having safe sex with casual partners. Participants in the 3-session HIV education study also evidenced a significant increase in the proportion of participants having safe sex with regular partners. In the trials without HIV education, no change in safe sex practices was found, and change in condom use was observed only among female participants. Conclusions. These findings are consistent with recommendations that HIV education/counseling should be provided to individuals in substance abuse treatment. A randomized controlled trial to confirm these results may be warranted. This trial is registered with NCT00033033, NCT00086255, NCT00015106, and NCT00015132. 1. Introduction Approximately 47,800 Americans contract HIV annually, with sexual contact accounting for about 87% of transmissions [1]. Multiple studies have established an association between crack/cocaine use and increased sexual risk behavior (SRB) [2–4]. While drug abuse treatment is, in and of itself, HIV prevention [5], a comprehensive approach includes HIV education/counseling to help patients reduce risky behaviors [6]. However, a 2011 survey of substance treatment programs in the United States found that 43% do not provide HIV education/counseling [7]. Research on the efficacy of HIV education for reducing SRB in crack/cocaine users has been primarily limited to out-of-treatment individuals [8–10]. To our knowledge, two studies have evaluated the efficacy of HIV education for cocaine dependent individuals in treatment and they focused on the ability of the intervention to increase HIV/AIDS knowledge and not on reducing SRB [11, 12]. Substance treatment programs have limited resources and, thus, the HIV education offered typically needs to be simple and to require minimal or no supervision. The question is whether such HIV education would be effective
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