This project assesses methods for decreasing HIV-risk behaviors in substance abusers, and assesses the safety and efficacy of pharmacological and behavioral treatments for opioid dependence in those already infected with HIV. A randomized clinical trial examined whether sustained HIV-protective behaviors can be achieved by adding a cognitive-behavioral coping-skills and relapse-prevention intervention to voucher-based contingency management has been completed. Inner-city methadone-maintained cocaine abusers were taught: 1) to identify and seek out sources of reinforcement that do not carry risks of HIV; and 2) to develop adaptive problem-focused and emotion-focused coping responses to general and drug-specific stressors that might otherwise trigger HIV-risk behaviors. Data are being analyzed. In another study, we evaluated whether hospitalized HIV-infected African-American women reported different dru-use patterns and presented with different medical conditions than their male counterparts. Participants were 321 African-American HIV+ patients admitted to an inner-city tertiary-care teaching hospital over a two-year period. Participants were selected on the basis of self-reported past or current opiate use. Compared to men, women were more likely to report a history of drug treatment, but were also more likely to report feeling currently dependent on heroin and to report current heroin use. Women also had significantly higher CD4 cell counts than men, and were more likely to be admitted for "Soft Tissue Infection/Fever" as opposed to "Opportunistic Infections." Sex differences in medical presentation (CD4 count and reason for admission) were concentrated among current users of heroin. Thus, in this sample of hospitalized, HIV-positive African-Americans, women were more likely to be current users, despite more reports of treatment seeking, and were more likely to be admitted due to the health consequences of current drug use. We are currently analyzing screening data from this trial to evaluate a brief interview for identification of hospitalized patients at risk for developing opioid abstinence syndrome.