Adults with severe mental illness (SMI) living in urban areas constitute a population at increased risk for HIV infection. Although previous research has shown moderate efficacy of HIV cognitive-behavioral risk reduction interventions for reducing HIV risk behavior among samples of SMI adults, improvements in intervention designs are needed to enhance and sustain HIV risk behavior change in this population. Studies show that the majority of adults with SMI use alcohol and that that alcohol use is closely tied to HIV sexual risk. As alcohol use may directly and indirectly affect HIV risk reduction behavior change, interventions that first directly and effectively address alcohol use, then address HIV risk behavior change may evidence enhanced and more sustainable sexual risk reduction outcomes for alcohol-using SMI adults. The proposed study will test the hypothesis that HIV prevention outcomes for SMI alcohol-using adults will be most successful among participants who first attend an intensive, individualized brief alcohol treatment intervention, then attend a cognitive-behavioral small-group HIV risk reduction intervention. The study will recruit 402 SMI adults (201 men and 201 women) who have engaged in high-risk sexual transmission acts in the past 90 days, and who use alcohol as measured by the AUDIT. Following baseline assessment of psychiatric diagnosis, sexual practices, alcohol use and other risk-related characteristics, participants will be randomly assigned within gender and in equal numbers to: 2 one-on-one alcohol education sessions followed by a 5-session small-group health education workshop (a contact match minimal intervention comparison condition); or 2 one-on-one alcohol education sessions followed by a 5-session HIV risk reduction skills building intervention focusing on making behavioral changes to reduce HIV risk; or 2 one-on-one alcohol treatment sessions founded in Motivational Enhancement Therapy designed to help participants reduce their alcohol use, followed by the same 5-session small-group HIV risk reduction intervention presented in condition 2. Followup risk assessments will be conducted with participants 3-, 6-, 9-, and 12-months post-intervention. We hypothesize that participants in the alcohol treatment/HIV risk reduction condition will show: greatest reduction in frequency of unprotected sexual acts and greatest increase in proportion of protected sexual acts; greatest change in HIV risk-related characteristics; and the most sustainable effects over the 12-month assessment period. If successful, this research will suggest a potentially important and cost-effective way to strengthen the effectiveness of HIV prevention interventions for an important subpopulation of SMI adults.
| Weinhardt, Lance S; Otto-Salaj, Laura L; Brondino, Michael J et al. (2002) Sex-related alcohol expectancies predict sexual risk behavior among severely and persistently mentally ill adults. Psychol Addict Behav 16:64-7 |
