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


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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    ABSTRACT: People diagnosed with severe mental illness (SMI) are at greater risk of HIV than the general population. However, little attention has been given to how best to reduce sexual risk taking in this group. The aim of the review was to evaluate the effectiveness of behavioural interventions to promote sexual safety behaviour in people diagnosed with SMI. A comprehensive search of relevant databases was undertaken, and studies were included if they were randomized, controlled trials; behavioural intervention related to sexual behaviour; included adults diagnosed with SMI; and if a behavioural outcome was reported. The Cochrane Assessment of Bias Tool was used. Of the initial 515 papers identified, 11 trials were included for quality assessment and data extraction. The studies were heterogeneous in content and dose of intervention, as well as outcome measure and follow-up periods, and all had some risk of bias. Four of the studies demonstrated significant improvement in safer sexual behaviour at follow up, but this effect diminished over time. The effect sizes were extremely variable. There is emerging evidence to suggest that a behavioural intervention has the potential to reduce sexual risks in people diagnosed with SMI. However, further high-quality research is needed in this area.
    Full-text · Article · Apr 2014 · International journal of mental health nursing
    • "For instance, extant programs targeting voluntary counseling and testing seekers have been reported to be effective.[42] Mental health care settings may provide appropriate opportunities for such HIV risk reduction interventions.[43] Improved knowledge may increase their ability to accurately assess and respond to risky situations. "
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    ABSTRACT: Few studies in Nigeria have investigated HIV risk behavior among persons with severe mental disorders. This study examined HIV risk behavior and associated factors among patients receiving treatment at a Nigerian psychiatric hospital. To determine the HIV risk behavior in persons with severe mental disorders in a psychiatric hospital. This was a cross-sectional survey involving 102 persons with serious mental disorders receiving treatment at a major psychiatric facility in Southwestern Nigeria. HIV risk screening instrument was self-administered to assess HIV risk behavior. A questionnaire was used to elicit socio-demographic variables while alcohol use was assessed with the alcohol use disorder identification test. Differences in HIV risk levels were examined for statistical significance using Chi square test. Forty eight percent of the respondents engaged in HIV risk behavior. This study revealed that 10.8% (11/102) gave a history of sexually transmitted disease, 5.9% (6/102) reported sex trading and no reports of intravenous drug use was obtained. A single risk factor was reported by 19.6% (20/102), 12.7% (13/102) reported two risk factors and 15.7% (16/102) reported three or more risk factors. HIV risk behavior was significantly related to alcohol use (P = 0.03). Mental health services provide an important context for HIV/AIDS interventions in resource-constrained countries like Nigeria.
    No preview · Article · Mar 2013
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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: This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and postintervention and at 3- and 6-month follow-ups. Patients receiving the HIV-risk-reduction intervention reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safer sex communications, improved HIV knowledge, more positive condom attitudes, stronger condom use intentions, and improved behavioral skills relative to patients in the SUR and control conditions. Patients receiving the SUR intervention reported fewer total and casual sex partners compared with control patients. Exploratory analyses suggested that female patients and patients diagnosed with a major depressive disorder were more likely to benefit from the HIV-risk-reduction intervention.
    Full-text · Article · May 2004 · Journal of Consulting and Clinical Psychology
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