Brief article Magdalena Pilot Project: motivational outreach to substance abusing women street sex workers Carolina E. Yahne, Ph.D.*, William R. Miller, Ph.D., Lilly Irvin-Vitela, M.C.R.P., J. Scott Tonigan, Ph.D. The University of New Mexico, Center on Alcoholism, Substance Abuse, & Addictions (CASAA), Albuquerque, NM 87106, USA Received 22 September 2001; received in revised form 23 February 2002; accepted 28 February 2002 Abstract The Magdalena Pilot Project provided outreach to Albuquerque women sex workers who were also using illicit drugs, primarily cocaine and heroin. This initial uncontrolled trial evaluated the feasibility and potential impact of motivational interviewing (MI) on change in drug use and HIV risk behaviors. Twenty-seven women were enrolled and interviewed about their substance use, health risk behaviors, and plans for change, using the client-centered, directive method of MI. Four months later, 25 women (93%) were interviewed again to assess their drug use and health risk behaviors. Large reductions were reported in frequency (days) of drug use and sex work, with a corresponding increase in days of lawful employment. In identifying problems that most needed to be addressed in order to help them live healthier lives, the women prioritized (1) basic needs including decent housing, (2) mental health care, and (3) treatment for substance use disorders. D 2002 Elsevier Science Inc. All rights reserved. Keywords: Motivational interviewing; Substance use disorder; HIV/AIDS; Prostitution; Women 1. Introduction Women street sex workers are at high risk for drug abuse, violence, and disease. They are also underserved in treat- ment facilities and in the justice system (Koss, 2000). Outreach to this vulnerable and disenfranchised population has met with some success (Weiner, 1996). For example, an epidemiological survey of 43 women street prostitutes in Albuquerque revealed most were very responsive to information and appeared likely to attempt to protect them- selves by using condoms and clean needles, indicating street-based outreach programs could be effective (Tabet, Palmer, Wiese, Voorhees, & Pathak, 1992). Motivational interviewing (MI) is a brief counseling method designed to evoke intrinsic motivation for change in health risk behaviors by resolving ambivalence (Miller & Rollnick, 2002). Most people who engage in risky and/or addictive behaviors are at least somewhat aware of the risks and costs associated with their action, yet they also experi- ence positive reinforcement from the behavior. Resolution of this ambivalence in the direction of positive change is the central goal of MI. MI has shown promise in enhancing treatment retention and behavior change among alcohol and other drug abusers (Miller & Rollnick, 2002), and clients with dual disorders (Swanson, Pantalon, & Cohen, 1999). Finally, MI has benefited prevention of HIV/AIDS (Carey et al., 1997). As an extension of an ongoing clinical trial of MI among drug-dependent individuals (R01-DA09864) in Albuquer- que, we initiated the Magdalena Pilot Project for outreach to women street sex workers who also used illicit drugs. The need for this specific outreach was suggested by our clinical encounters with a number of women who were commercial sex workers and by international research highlighting three methods that have been used successfully in countries with low HIV infection rates: (1) early prevention efforts; (2) a readily available supply of sterile syringes; and (3) outreach using trusted communication (Des Jarlais, 1999). MI is specifically designed to establish trust and enhance behavior change within relatively brief encounters. For these reasons, 0740-5472/02/$ – see front matter D 2002 Elsevier Science Inc. All rights reserved. PII:S0740-5472(02)00236-2 * Corresponding author. The University of New Mexico, Center on Alcoholism, Substance Abuse, & Addictions (CASAA), 2650 Yale SE, Albuquerque, NM 87106, USA. Tel.: +1-505-265-8456; fax: +1-505- 768-0125. E-mail address: cyahne@unm.edu (C.E. Yahne). Journal of Substance Abuse Treatment 23 (2002) 49 – 53