Worldwide, people with severe mental illness (SMI) have been found to be at extremely elevated risk for human immunodeficiency virus (HIV). A recent study has documented an HIV seroprevalence among SMI in Brazil five times higher than the general population and several studies have documented sexual risk- taking among SMI. Despite a well documented AIDS crisis in Brazil and the Brazilian government's commitment to HIV prevention for the whole society, Brazilian SMI are not regularly offered tested HIV prevention interventions. The goal of this study is to build on the successful findings of our NIMH funded pilot study (R01-65163-01) that adapted, refined, and piloted an HIV prevention intervention for men and women with SMI in Brazil, based on HIV prevention interventions found to be efficacious for the SMI in the US. Our pilot study established the need for and feasibility of conducting an RCT to test the efficacy of a theory-based, small-group, provider-delivered intervention that focuses on improving knowledge, motivation, and behavioral skills (1MB Model) to reduce HIV sexual risk behavior among SMI. We propose to continue to build our current community partnerships and to expand the collaboration to include the Municipality of the city of Rio de Janeiro. AH nine municipal community mental health clinics (Centers for Psycho-Social Assistance-CAPS) in Rio de Janeiro will serve as sites for the proposed study. Using sites that are representative of outpatient treatment delivery settings across Brazil, will inform future HIV prevention services. We propose to conduct an RCT to test the long-term efficacy of our Brazilian HIV Prevention Intervention for men and women with SMI (eight sessions plus three boosters six months later) assessing sex risk behavior at baseline, and 3, 6 and 12 months post-intervention;HIV knowledge, motivation and behavioral skills will also be assessed together with the impact of mental illness stigma and psychiatric symptoms on sex risk behavior. Our history of working together exemplifies compatible, equitable international research collaboration and partnership with bidirectional capacity building of community, academic and service setting members. This study will lay a foundation for future HIV prevention services implementation within the system of psychiatric care in Brazil. Further, if efficacious, our intervention-and the process of collaboration we used to develop it-will be a model that can be implemented in a variety of public health settings worldwide.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Pequegnat, Willo
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New York State Psychiatric Institute
New York
United States
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Wainberg, Milton L; McKinnon, Karen; Norcini-Pala, Andrea et al. (2018) Ending AIDS as a Public Health Threat: Treatment-as-Usual Risk Reduction Services for Persons With Mental Illness in Brazil. Psychiatr Serv 69:483-486
Norcini Pala, Andrea; McKinnon, Karen; Wall, Melanie M et al. (2017) An index to examine the sexual HIV risk of psychiatric service users based on sexual partners. Braz J Psychiatr 39:189-190
Wainberg, Milton L; Cournos, Francine; Wall, Melanie M et al. (2016) Mental illness sexual stigma: Implications for health and recovery. Psychiatr Rehabil J 39:90-6
GuimarĂ£es, Mark D C; McKinnon, Karen; Cournos, Francine et al. (2014) Correlates of HIV infection among patients with mental illness in Brazil. AIDS Care 26:505-13
Cournos, Francine; GuimarĂ£es, Mark D C; Wainberg, Milton L (2012) HIV/AIDS and serious mental illness: a risky conclusion. Psychiatr Serv 63:1261; author reply 1261-2
Melo, Ana Paula Souto; McKinnon, Karen; Wainberg, Milton L et al. (2012) Psychiatric patients' return for HIV/STI test results in mental health centers. Rev Saude Publica 46:290-9
Elkington, Katherine S; McKinnon, Karen; Mann, Claudio Gruber et al. (2010) Perceived mental illness stigma and HIV risk behaviors among adult psychiatric outpatients in Rio de Janeiro, Brazil. Community Ment Health J 46:56-64
Wainberg, Milton L; Alfredo Gonzalez, M; McKinnon, Karen et al. (2007) Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness. Soc Sci Med 65:296-308
Pinto, Diana de Souza; Mann, Claudio Gruber; Wainberg, Milton et al. (2007) Sexuality, vulnerability to HIV, and mental health: an ethnographic study of psychiatric institutions. Cad Saude Publica 23:2224-33
Wainberg, Milton L; McKinnon, Karen; Mattos, Paulo E et al. (2007) A model for adapting evidence-based behavioral interventions to a new culture: HIV prevention for psychiatric patients in Rio de Janeiro, Brazil. AIDS Behav 11:872-83