HIV Risk Reduction for Substance Using Seriously Mentally Ill Adults: Test of the Information-Motivation-Behavior Skills (IMB) Model

Abstract

The information-motivation-behavioral skills (IMB) model (Fisher & Fisher, 1992) was used as the theoretical framework for predicting unprotected sexual behavior among substance abusing men and women diagnosed with serious mental illnesses (n = 320; 150 men and 170 women, primarily of minority ethnicity). In a structural equation model, gender, HIV transmission knowledge, and motivational variables of pro-condom norms and attitudes, and perceived susceptibility predicted behavioral skills markers: condom use skills and condom use self-efficacy. Along with the other variables in the model, condom skills and condom self-efficacy were hypothesized to predict condom use over a six-month period. Results showed that greater condom skills were predicted by female gender, positive condom attitudes, and transmission knowledge. Engaging in lower rates of unprotected sex was predicted by pro-condom norms, less perceived susceptibility, and greater condom self-efficacy. Positive attitudes toward condoms had a significant indirect effect on rates of unprotected sex, exerting its influence through condom use self-efficacy. Results suggest that changing personal attitudes about condoms and reinforcing pro-condom attitudes among significant others will encourage condom use among seriously mentally ill (SMI) adults who are at high risk for HIV and other sexually transmitted diseases (STDs). KeywordsHIV AIDS prevention; psychiatric patients; seriously mentally ill adults Recent years have seen remarkable breakthroughs in the treatment of HIV infection and there is some evidence for a leveling of new HIV infections in some subpopulations (CDC, 2001). Along with these reasons for hope, however, is the continued spread of HIV in US inner-cities, particularly among impoverished and disenfranchised populations. Among those at greatest risk for HIV infection are adults with serious and persistent mental illnesses living in high HIV prevalence cities. (Carey, Weinhardt, & Carey, 1995;Cournos & McKinnon, 1997). One study of over 500 psychiatric patients found that 6% were HIV infected (Stewart, Zuckerman, & Ingle, 1994) and Rosenberg et al. (2001) reported 3% HIV seroprevalence in a large and ethnically diverse sample of seriously mentally ill (SMI) adults. These rates of HIV infection exceed those in the general population and are often higher than rates found in the highest risk groups, such as injection drug users and sexually transmitted disease (STD) clinic patients (Carey et al., 1997a).The alarming numbers of HIV infected adults with serious mental illness are exacerbated by high-rates of unprotected sexual activity routinely found in SMI adults (e.g., Kalichman, Kelly, Johnson, & Bulto, 1994;Carey et al., 1997a). Seriously mentally ill adults often have the same risk factors identified in other at-risk populations, such as substance-related disorders which may occur in more than half of people with diagnosed mental disorders (Mueser et al., 1990(Mueser et al., , 1995Drake et al., 1991). HIV risks have also been associate...

The Role of Self-Efficacy and Motivation to Explain the Effect of Motivational Interviewing Time on Changes in Risky Sexual Behavior among People Living with HIV: A Mediation Analysis

“…According to the information-motivation-behavioral skills model, motivation to reduce AIDS risk is one of the three factors contributing to AIDS risk reduction behavior [17]. Enhancement of self-efficacy and increased motivation to practice safer sex are significant components of several effective behavioral change interventions aimed at reducing unsafe sex [9, 18–21]. …”

Sexual Risk among Impoverished Women: Understanding the Role of Housing Status

“…Perceiving that oneself is at risk of infection with HIV (perceived susceptibility) is an important indicator of motivation to engage in HIV prevention behaviors (Fisher & Fisher, 1992;Kalichman, Malow, Devieux, Stein, & Piedman, 2005;Sheeran, Abraham, & Orbell, 1999). Greater perceived susceptibility to HIV/AIDS has been associated with greater risk reduction behaviors such as condom use (Ashery, Wild, Zhao, Rosenshine, & Young, 1997;Sheeran et al, 1999).…”

Social Psychology and the Fight Against AIDS

“…supported by data collected from highly diverse populations that are of considerable relevance to the HIV epidemic, including, for example, men who have sex with men (MSM) (Fisher et al, 1994), adolescents (Fisher et al, 1999;Kalichman, Stein, et al, 2002;Robertson et al, 2006;Ybarra et al, 2013), university students (Bazargan et al, 2000(Bazargan et al, , 2010Fisher et al, 1994;Reis et al, 2013), low-income urban women , IDUs (Bryan et al, 2000), patients attending sexually transmitted infection (STI) clinics (Crosby et al, 2008;Kalichman et al, 2006;Mittal et al, 2012;Scott-Sheldon et al, 2010;Walsh et al, 2011), individuals with mental illness (Kalichman, Malow, et al, 2005), female commercial sex workers (Zhang et al, 2011), truck drivers (Bryan et al, 2001), and people living with HIV/AIDS (PLWH) . The propositions of the IMB model have received consistent empirical support in culturally and geographically diverse locations including Angola, Portugal, Malawi, and India, and multiple culturally and ethnically distinct settings in South Africa and the United States.…”