The goal of this project is to design and test an intervention to reduce sexual and injection practice risk behaviors among 1,200 HIV-infected men and women in order to decrease the likelihood that persons with HIV will transmit infection to others and to promote other health-related behavior changes in PLH. The research will be focused on three HIV+ subgroups: women, men who have sex with men (MSM), and injection drug users (IDUs). The study will be undertaken at four sites: Los Angeles, New York, San Francisco, and Milwaukee. The project will begin with a 1-year period of formative Phase 1 studies conducted with 150 PLH, using qualitative and life-history interviews to characterize the physical, social, and interpersonal contexts that influence risk behavior among PLH; understand stages of adaptation to serostatus; and identify barriers to implementation of safer sex, positive health care acts, and quality of life. The formative research phase will also allow the investigators to tailor the social action theoretical model guiding the intervention to address issues affecting each subpopulation. Following the formative research phase, a manual will be prepared for an intervention of 15 individually-delivered sessions organized into three modules with components that target health promotion, transmission risk reduction, and psychological coping/relationship issues. In the Phase 2 main intervention trial, three subgroups of HIV-infected person who have recently engaged in high-risk behavior will be recruited in equal numbers at each site yielding study-wide samples of HIV+ women (N=400), MSM (N=400), and IDUs (N=400). Altogether, 1,200 PLHs project-wide will be randomly assigned in equal numbers within each subgroup to an immediate intervention condition or to a lagged intervention control condition. Following two baseline interviews, participants will be evaluated at 5-month intervals for the next 35 months. In addition to anticipating changes in the primary (transmission risk acts) and secondary (health care behaviors and quality of life) outcomes over time and in response to each module, the investigators will examine the impact of mediating factors emerging from social action theory (coping skills, social support problem solving, HIV-related attitudes/beliefs, and environmental context of risk acts), as well as participant background factors (gender, ethnicity, history of transmission behaviors) or primary and secondary outcomes. The study will be implemented by a consortium of four sites in order to provide sufficient sample sizes to assess the impact of the intervention; to enhance generalizability of the findings; and to utilize the specialized expertise of each research team. Cost-effectiveness analyses and dissemination are planned as part of this study.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH057615-03
Application #
6185805
Study Section
Psychobiological, Biological, and Neurosciences Subcommittee (MHAI)
Program Officer
Pequegnat, Willo
Project Start
1998-09-05
Project End
2003-07-31
Budget Start
2000-08-01
Budget End
2001-07-31
Support Year
3
Fiscal Year
2000
Total Cost
$1,376,099
Indirect Cost
Name
University of California Los Angeles
Department
Type
Other Domestic Higher Education
DUNS #
119132785
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Comulada, W Scott; Rotheram-Borus, Mary Jane; Pequegnat, Willo et al. (2010) Relationships over time between mental health symptoms and transmission risk among persons living with HIV. Psychol Addict Behav 24:109-18
Steward, Wayne T; Charlebois, Edwin D; Johnson, Mallory O et al. (2008) Receipt of prevention services among HIV-infected men who have sex with men. Am J Public Health 98:1011-4
Remien, Robert H; Hirky, A Elizabeth; Johnson, Mallory O et al. (2003) Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four US cities. AIDS Behav 7:61-72
Wight, R G; Rotheram-Borus, M J; Klosinski, L et al. (2000) Screening for transmission behaviors among HIV-infected adults. AIDS Educ Prev 12:431-41