Recent studies have shown that chronic mentally ill adults living in the community are at elevated behavioral risk for contracting HIV infection, and that HIV seroprevalence is already high among the chronic mentally ill. Vulnerability to HIV risk behavior in this population is associated with characteristics of severe mental illness (often including poor social problem solving, impulsivity, sexual acting out, and co-existing substance use); risk-producing social interaction patterns (including having transient social and sexual relationships, vulnerability to exploitation and coercion, and relationships with others who share similar problems); and the urban inner-city environment where many chronic mentally ill persons live, areas where HIV, STD's, and drug abuse are increasingly common. A one-year period of support for pilot work resulted in studies that have established risk behavior characteristics in a sample of ethnically-diverse chronic mentally ill adult men and women and that have permitted opportunities to pilot test risk behavior assessment measures. This renewal application request support to now begin a controlled trial of a cognitive-behavioral HIV risk reduction intervention based on social learning principles already successfully used in other """"""""community living"""""""" approaches for the chronic mentally ill. From the patient population of urban mental health clinics, 200 men and 200 women who meet criteria for high HIV risk will be recruited. All participants will be assessed using a battery of measures of risk knowledge and intentions; cognitive and behavioral skills pertinent to risk reduction change; sexual and substance use behavior; and presence of STD's. Two hundred participants will be randomly assigned to a 10- session group intervention program which includes risk education, behavior change planning, training in cognitive and behavioral risk reduction skills, and reinforcement of change efforts. The other 200 participants will attend a comparison intervention focused on health behavior change in areas unrelated to AIDS. All participants will be reassessed at postintervention and through an 18-month follow-up to determine intervention effectiveness. It is hypothesized that HIV intervention participants will exhibit increased risk knowledge, improved behavior and cognitive risk reduction skills, less frequent high-risk behavior, and lower rates of STD's at follow-up. The intent of this work is to develop and evaluate an HIV prevention model that can be practically implemented by community mental health programs which serve the chronic mentally ill.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH049031-04
Application #
2248568
Study Section
Psychobiological, Biological, and Neurosciences Subcommittee (MHAI)
Project Start
1992-03-01
Project End
1997-08-31
Budget Start
1995-09-01
Budget End
1996-08-31
Support Year
4
Fiscal Year
1995
Total Cost
Indirect Cost
Name
Medical College of Wisconsin
Department
Psychiatry
Type
Schools of Medicine
DUNS #
073134603
City
Milwaukee
State
WI
Country
United States
Zip Code
53226
Otto-Salaj, Laura L; Gore-Felton, Cheryl; McGarvey, Elizabeth et al. (2002) Psychiatric functioning and substance use: factors associated with HIV risk among incarcerated adolescents. Child Psychiatry Hum Dev 33:91-106
Pinkerton, S D; Johnson-Masotti, A P; Otto-Salaj, L L et al. (2001) Cost-effectiveness of an HIV prevention intervention for mentally ill adults. Ment Health Serv Res 3:45-55
Otto-Salaj, L L; Stevenson, L Y (2001) Influence of psychiatric diagnoses and symptoms on HIV risk behavior in adults with serious mental illness. AIDS Read 11:197-204, 206-8
Otto-Salaj, L L; Kelly, J A; Stevenson, L Y et al. (2001) Outcomes of a randomized small-group HIV prevention intervention trial for people with serious mental illness. Community Ment Health J 37:123-44
Otto-Salaj, L L; Heckman, T G; Stevenson, L Y et al. (1998) Patterns, predictors and gender differences in HIV risk among severely mentally ill men and women. Community Ment Health J 34:175-90
Kelly, J A (1997) HIV risk reduction interventions for persons with severe mental illness. Clin Psychol Rev 17:293-309
Kalichman, S C; Sikkema, K J; Kelly, J A et al. (1995) Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults. Psychiatr Serv 46:275-80
Kalichman, S C; Kelly, J A; Johnson, J R et al. (1994) Factors associated with risk for HIV infection among chronic mentally ill adults. Am J Psychiatry 151:221-7