Article

HIV risk reduction for the seriously mentally ill: Pilot investigation and call for research

Syracuse University, Syracuse, U.S.A.
Journal of Behavior Therapy and Experimental Psychiatry (Impact Factor: 2.23). 06/1997; 28(2):87-95. DOI: 10.1016/S0005-7916(97)00002-5

ABSTRACT Research indicates that people with serious mental illnesses (SMI; e.g., schizophrenia, schizoaffective disorder, bipolar disorder) are at enhanced risk for infection with the human immunodeficiency virus (HIV). To decrease this risk, we piloted a six-session HIV-risk reduction intervention for two single-gender groups (nine women, eight men; M age = 39.8 years) of SMI outpatients. The intervention and assessment were based on the Information-Motivation-Behavioral Skills model of HIV-preventive behavior (Fisher & Fisher, 1992. Psychological Bulletin., 455–474) and employed activities designed specifically for people with a SMI. Data were collected at pre- and post-intervention, and at a one-month follow-up. Results indicated that this brief intervention resulted in enhanced HIV-related knowledge, and trends toward enhanced skill at condom use negotiation and condom use self-efficacy. Overall, a modest decrease in risk behavior among participants was observed. Thus, this pilot investigation revealed that HIV-related risk of the SMI can be reduced through traditional behavioral skills and education methods. Future research employing control groups, more intensive interventions, and baseline screening for high risk is encouraged.

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    • "It was interesting to note that two demographic characteristics seemed to influence outcomes in some of the studies: gender and type of mental illness. In two trials (Katz et al. 1996; Weinhardt et al. 1997), with both male and female participants, the participants' data could be analysed by gender. The results of those trials found that that women were more likely to reduce sexual risk taking following participation in the interventions compared to men. "
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    • "We interpreted these findings as suggestive that patients who could most benefit from risk-reduction interventions were more likely to participate. Thus, findings from the current trial corroborate findings obtained in earlier trials with fewer sessions (Kalichman et al., 1995;Kelly et al., 1997;Otto-Salaj et al., 2001;Weinhardt et al., 1997). Taken together, the recruitment and retention data demonstrate the feasibility of implementing HIV-risk-reduction interventions with psychiatric outpatients. "
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    ABSTRACT: Individuals diagnosed with a severe mental illness are at significantly enhanced risk for infection with the human immunodeficiency virus (HIV). To better understand elevated seroprevalence in this population, we review the research literature that has investigated HIV-related risk behavior among adults who have a severe and persistent mental illness. This review indicates that 54%–74% of adults report that they have been sexually active in the last year with approximately one third reporting two or more partners. Among those who were sexually active, condom use was inconsistent. A significant minority (4 %–35 %) of adults also reported a history of injection drug use. Overall, the data indicate that the severely mentally ill engage regularly in practices known to involve increased risk for HIV transmission. We introduce and modify Fisher and Fisher's (1992) theoretical model to organize the possible determinants of HIV-related risk taking among severely mentally ill adults, and encourage use of this model in the design of behavioral epidemiological and risk reduction studies. We also identify several methodological challenges to HIV-related research, including problems associated with the use of self-report measures; diagnostic imprecision; and participant recruitment and retention.
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