Human Immunodeficiency Virus Sexual Risk Reduction in Homeless Men With Mental Illness

Süsser, Ezra; Valencia, Eliecer; Berkman, Alan; Sohler, Nancy; Conover, Sarah; Torres, Júlio César Nogueira; Betne, Prabha; Felix, Alan; Miller, Sutherland

doi:10.1001/archpsyc.55.3.266

Cited by 80 publications

(100 citation statements)

References 48 publications

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“…Awareness of these issues energized the development of interventions to help change attitudes and reduce sexual risk behavior (Carey et al, 2004;Collins, Geller, Miller, Toro, & Susser, 2001;Susser et al, 1998). Successful interventions in North America help people with SMI acquire skills to use and negotiate condom use.…”

Section: Hiv Risk Among People With Mental Illnessmentioning

confidence: 99%

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

Collins

2006

Social Science & Medicine

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Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.

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Section: Hiv Risk Among People With Mental Illnessmentioning

confidence: 99%

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

Collins

2006

Social Science & Medicine

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“…The primary strategy has been cognitivebehavioral, small group interventions that develop individual competencies (e.g., condom use, sexual assertiveness and negotiation, problem solving) to reduce sexual risk behavior (e.g., Carey et al, 2004;Otto-Salaj, Kelly, Stevenson, Hoffman, & Kalichman, 2000;Susser et al, 1998). However, intervention effects have been modest, tend to diminish over time, and are almost always delivered in clinical settings (e.g., Meade & Sikkema, 2004).…”

Section: Hiv Risk Reduction For Persons With Smimentioning

confidence: 99%

Negotiating Risk: Knowledge and Use of HIV Prevention by Persons With Serious Mental Illness Living in Supportive Housing

Kloos

Gross

Meese

et al. 2005

American Journal of Community Psychology

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As a population, persons with serious mental illness (SMI) have an elevated risk for HIV infection. However, relatively little is known about how the risk of HIV has affected their lives, how persons with SMI evaluate their HIV risk, and what preventive measures they undertake. Furthermore, relatively little is known about community-based HIV prevention for persons with SMI as most interventions have been restricted to clinical settings. This report presents findings on the HIV-related experiences of persons with SMI living in supportive housing programs, one possible setting for implementing community-based HIV prevention with this population. The qualitative investigation interviewed 41 men and women living in five supportive housing programs. In-depth, qualitative interviews elicited discussion of research participants' (a) experiences with HIV, (b) knowledge about HIV and HIV prevention, (c) assessments of their own risk, (d) descriptions of how they apply their prevention knowledge, and (e) reports of barriers for HIV prevention. Research participants describe social networks that have substantial contact with persons affected by HIV. However, contrary to some expectations of persons with SMI, research participants report using HIV prevention knowledge in negotiating their risk of contracting HIV. The implications of these findings are discussed in terms of their relevance for implementing community-based HIV prevention for persons with SMI.

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“…HIV risk reduction interventions designed and tested with seriously mentally ill adults have been based on social cognitive theories of behavior change (Kalichman, Sikkema, Kelly, & Bulto, 1995;Otto-Salaj et al, 2001;Susser et al, 1998). Although a variety of theoretical frameworks have been used as the basis for prevention strategies targeted to the SMI, all of these interventions included information-education, motivational enhancement, and cognitive behavior skills building, all elements of the information-motivation-behavioral skills (IMB) model of health behavior (Fisher & Fisher, 1992).…”

Section: Introductionmentioning

confidence: 99%

“…Although these social and contextual factors provide insight into the risk behaviors of many men and women with serious mental illnesses, contextual characteristics do not translate directly into intervention strategies aimed at reducing risks. The potential for rapid spread of HIV among the SMI has led to the urgent call for the development of risk reduction interventions designed for people with serious mental illness.HIV risk reduction interventions designed and tested with seriously mentally ill adults have been based on social cognitive theories of behavior change (Kalichman, Sikkema, Kelly, & Bulto, 1995;Otto-Salaj et al, 2001;Susser et al, 1998). Although a variety of theoretical frameworks have been used as the basis for prevention strategies targeted to the SMI, all of these interventions included information-education, motivational enhancement, and cognitive behavior skills building, all elements of the information-motivation-behavioral skills (IMB) model of health behavior (Fisher & Fisher, 1992).…”

mentioning

confidence: 99%

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

Kalichman

Malow

Dévieux

et al. 2005

Community Ment Health J

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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...

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Human Immunodeficiency Virus Sexual Risk Reduction in Homeless Men With Mental Illness

Abstract: This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.

Cited by 80 publications

References 48 publications

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

Negotiating Risk: Knowledge and Use of HIV Prevention by Persons With Serious Mental Illness Living in Supportive Housing

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

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