Effects of a Cognitive-Behavioral HIV Prevention Intervention Among HIV Negative Male Substance Abusers in VA Residential Treatment

Abstract

This investigation compared the effectiveness of a cognitive-behavioral HIV risk reduction intervention with a standard care (SC) comparison condition in modifying HIV risk related knowledge, beliefs, attitudes, and behavior at 6-month and 12-month follow-ups among 149 HIV seronegative males. The two intervention conditions were administered while participants were in inpatient alcohol and other drug abuse treatment. Global drug abuse severity, as well as injection drug abuse, decreased significantly from preintervention to follow-up across conditions. There were significant increases in the proportions reporting sexual activity and increases in levels of unprotected sex acts between baseline and follow-up across conditions. However, no changes in sex risk behavior were found among those who reported sexual activity both prior to and after intervention across conditions. Participants revealed relatively adequate knowledge regarding HIV and HIV risk reduction practices, strong belief in the utility of safer practices and in their ability to enact such practices, and relatively strong commitment to practice safer sex across conditions at baseline assessment. In general, substantial postintervention improvements over baseline levels in these areas were not found. Relatively modest changes in sexual self-efficacy and in safe-sex guidelines were identified in analyses involving the total sample. Exploratory subgroup analysis suggested increases in knowledge and reductions in susceptibility and anxiety among those who reported sexual activity both prior to and after intervention. Among participants reporting initiation of sexual activity after intervention, those receiving SC revealed changes in perceived susceptibility and in condom attitudes. A discussion is presented of challenges associated with providing meaningful HIV risk reduction intervention when baseline levels of sex risk behavior, perceived HIV infection susceptibility, and HIV anxiety are only moderate and when initial levels of sexual self-efficacy and commitment are relatively high.

A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs

“…Examples of this work are Sorensen et al [140] and MacMahon et al [141] both of whom conclude that the brief intervention showed little additional effect on risk behaviour (see also [142]). …”

O consumo de álcool como fator de risco para a transmissão das DSTs/HIV/Aids

“…Em geral, as inter venções mais relatadas como eficientes foram cognitivo-comportamental, aconselhamento, entrevista motivacional e intervenção breve. A eficiência é vista por meio da apresentação da redução no uso de substâncias, tanto antes ou durante o ato sexual quanto em outros contextos, e do aumento de comportamento sexual seguro, quando esses dois fenô-menos estão associados (Jones et al, 2005;Naar-King et al, 2006;McMahon et al, 2001).…”

Behavioral Interventions for HIV-Positive and HCV-Positive Drug users

“…Unfortunately, prevention efforts directed toward drug users' sexual risks have generally had lower effect sizes than those directed towards injection risk behaviors (McMahon et al, 2001;Warner and Leukefeld, 2001;Prendergast et al, 2001). In a recent meta-analysis, Semaan et al (2002) examined the effectiveness of 33 U.S.-based HIV intervention studies in reducing the sexual risk behaviors of drug users by reducing unprotected sex or increasing the use of male condoms.…”