This application requests support as an Extramural Research Group (ERG) in the """"""""Cooperative Agreement for Multisite Trials of Behavioral Strategies to Prevent the Further Spread of HIV Infection."""""""" The proposed research will evaluate the impact of a cognitive-behavioral skills training group intervention for chronic mentally ill adults who engage in sexual behavior practices that confer high risk for HIV infection. Vulnerability to risk in this population is associated with characteristics of chronic mental illness (often including poor social problem solving, impulsivity, sexual acting out, and coexisting substance use); social interaction patterns that elevate risk (transient social and sexual relations often with others who share similar problems and vulnerability to exploitation or coercion); and the urban inner-city environment where many chronic mentally ill persons live and where HIV, STD's and drug use are common. This research will adapt social learning and cognitive-behavioral skills training principles already successfully used in other """"""""community living"""""""" interventions to the problem of HIV risk reduction for the chronic mentally ill. Following integration of the ERG project into the Cooperative Agreement protocol, a pilot study phase will (1) elicit information on risk knowledge, attitudes, and risk-producing situations encountered by the chronic mentally ill; (2) permit measure refinement; and (3) pilot test intervention techniques. Preliminary data already collected indicate that risk behavior and STD's are very common in this population. From the population of an inner-city mental health clinic, 300 persons (150 women and 150 men) who meet criteria for psychiatric illness and high-risk behavior will then be recruited. Subjects will be assessed with measures of risk knowledge, sexual and substance use behavior, cognitive and behavioral skill pertinent to risk reduction implementation, behavioral intentions, and STD incidence. 150 subjects will be randomly assigned to participate in multiple-session HIV risk reduction groups that include risk education, behavior change preparedness, training in skills to implement risk reduction (condom use, assertiveness, social problem solving), and reinforcement of change efforts. The other 150 subjects will participate in a time-matched health intervention on topics unrelated to AIDS. All subjects will be reassessed at postintervention and through 12-month followup to determine intervention effectiveness on risk knowledge, behavioral intentions, behavioral and cognitive skill related to change implementation, and high-risk behavioral as well as STD incidence at long-term followup. This work seeks to test a model that can be of practical benefit to community programs which serve the chronic mentally ill at risk for HIV infection.
