This is a two-arm randomized controlled trial (RCT) for 308 seriously mentally ill adults (SMI) engaging in risky sexual and/or drug use behavior comparing a brief HIV primary and secondary prevention intervention [Skills building and Motivational Interviewing (SB-MI) to Care as Usual (CAU)]. Outcomes will be measured at 3, 6, and 12 months. The SB-MI intervention (3 sessions + booster) was initially developed as the experimental condition in an R34 pilot project which demonstrated its feasibility and promise. For the proposed project, we will recruit a larger sample which includes men and women, with and without HIV, from various ethnic and racial groups, different sexual orientations and housing arrangements, a range of psychiatric disorders and functional capacities. In this way we can more rigorously demonstrate the promise of SB-MI for diverse people with SMI. We will also conduct a sub-study after the 6 month follow-up to examine the impact at 12 months of an additional booster session for SB-MI participants. Our primary aim is to examine the effectiveness of a brief, tailored primary and secondary risk reduction strategy to CAU for people with serious mental illness. The desired outcomes for this aim include: decreased frequency of risk behaviors (number of partners, number of encounters);increased use of barrier precautions and IV needle cleaning;positive changes in information, motivation, and risk behaviors associated with HIV and increased HIV Counseling and Testing for those who do not know their HIV status.
A second aim i s to examine the effectiveness of a 2nd booster session after the 6 month follow-up for 1/2 of participants randomized to SB-MI. The primary outcome will be decreased frequency of risk behaviors and increased use of barrier precautions at the 12 month follow-up for participants who receive a 2nd booster. Our hypotheses include: 1) Effect sizes for constructs of the IMB (Information, Motivation, Behavior) Model will be larger for participants randomized to the SB-MI condition compared to CAU. 2) Participants in SB-MI will demonstrate higher rates of accessing HIV counseling and testing at follow-up, as compared to participants in CAU. 3) SB-MI participants who receive a 2nd booster session will be significantly more likely to maintain behavior change at 12 months compared to SB-MI participants who do not receive the 2nd booster. Our long-term objective is to reduce the incidence of HIV risk behavior for SMI using a brief intervention which can be easily translated and adapted to "real world" settings.
Research findings increasingly support the contention that the incidence of HIV infection is high among people with serious mental illness (SMI). Our long-term objective is to reduce the incidence of HIV risk behavior for SMI using a brief intervention which can be easily translated and adapted to real world settings.