Description After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). ART adherence is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV. Methods A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation. Recommendations Recommendations are provided for monitoring of entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.

This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and postintervention and at 3- and 6-month follow-ups. Patients receiving the HIV-risk-reduction intervention reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safer sex communications, improved HIV knowledge, more positive condom attitudes, stronger condom use intentions, and improved behavioral skills relative to patients in the SUR and control conditions. Patients receiving the SUR intervention reported fewer total and casual sex partners compared with control patients. Exploratory analyses suggested that female patients and patients diagnosed with a major depressive disorder were more likely to benefit from the HIV-risk-reduction intervention.

This paper describes a series of 4 studies, designed to provide evidence of the feasibility, reliability, and validity of the Timeline Followback (TLFB) method when used to assess sexual risk behaviour with psychiatric outpatients. This population was selected because patients often have difficulty completing assessments of sexual risk behaviours due to deficits in attention, memory, and communication skills. All 4 studies demonstrated the feasibility of the HIV-risk TLFB. Study 1 also demonstrated that it can be completed in 20 min, and scored in less than 10 min. Qualitative data revealed that both patients and assessors found the features of the TLFB helpful. Study 2 provided evidence that the HIV-risk TLFB can be reliably scored by interviewers whereas Study 3 demonstrated that this measure can be completed reliably by patients and that TLFB of sexual behaviour were consistent over time. Study 4 provided initial evidence for the validity of the HIV-risk TLFB but also suggested that the TLFB may yield frequency estimates that are slightly less than those obtained with single-item measures. We conclude that the TLFB is feasible, reliable, and valid, even in a population known to have difficulty with self-report measures.

State Psychiatric Hospital outpatients (93 men, 69 women) diagnosed with a serious persistent mental illness (SPMI) completed the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST-10) by interview as part of a general health/behavior screening instrument. Responses to the AUDIT and DAST-10 were compared with criteria of current diagnosis and occurrence of symptoms in the last year for both alcohol and drug use disorders, respectively. Results showed that for both diagnosis and symptoms, AUDIT cutpoints of 7 and 8 had good sensitivity and specificity, and DAST-10 cutpoint of 2 was identified for both criteria. These and other findings suggest that both instruments have promising clinical utility when used with individuals diagnosed with an SPMI.

This experiment tested the effects of alcohol and expectancies on determinants of safer sex according to the Information-Motivation-Behavioral Skills model. Sixty heterosexual women attended two sessions. During session 1, participants completed a set of descriptive measures; during session 2 they were randomly assigned to one of four beverage conditions: control, alcohol/low (.35 gm alcohol/kg. body weight), alcohol/moderate (.70 gm alcohol/kg. body weight), or placebo. After beverage consumption, all participants completed measures of motivation to engage in risky sex and condom use negotiation skills. Results showed that the higher dose of alcohol and stronger alcohol expectancies were associated with greater motivation to engage in risky sexual behavior. However, perceived intoxication, rather than actual alcohol consumption or expectancies, was the best predictor of condom use negotiation skills. Integration of the findings with past research and their implication for the design of HIV prevention programs are discussed.Despite the decline in the incidence of HIV transmission in the United States for males during the 1990s, the rates increased for heterosexual women in the young adult age range (18-30 years; Karon, Fleming, Steketee, & De Cock, 2001;Logan, Cole, & Leukefeld, 2002). Although there have been major advances in pharmacological management of HIV disease in recent years, this disease has no known cure. Accordingly, emphasis continues to be placed on the prevention of HIV transmission (Centers for Disease Control, 2000).Because of the importance of prevention of HIV infection, many studies of the hypothesized determinants of condom use, including alcohol use, have been conducted. The large majority of these studies have been cross-sectional, interview or survey studies of a variety of population subgroups. The most useful of these studies for describing the association between acute alcohol intoxication and failure to use condoms or other risky (for transmission of HIV) sexual practices are event-level studies (Leigh, 2002;Weinhardt & Carey, 2001). Both Leigh's and Weinhardt and Carey's reviews show that there is no general, negative association between acute alcohol intoxication and the use of condoms during sex, as global association studies have implied. Instead, the relationship between acute alcohol intoxication and the likelihood of the occurrence of risky sexual behavior seems to be dependent on characteristics of the individuals involved and contextual factors.Correspondence should be sent to Stephen A. Maisto, Department of Psychology and Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244-2340. Electronic mail may be sent to samaisto@psych.syr.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe correlational research literature on the determinants of HIV/AIDS risky sexual behavior has helped to advance knowledge about factors associated with such behavior, with consequent improvement in the e...