Interventions that provide HIV-related information, motivational enhancement and skills training can help patients with mental illnesses, especially severe depression, reduce risky sexual behavior better than basic outpatient care alone, according to new findings by a Syracuse University psychologist.
Michael Carey, PhD, says the results of his study, published in APA's Journal of Consulting and Clinical Psychology (Vol. 72, No. 2), warrant attention because people with severe mental illnesses often lack the interpersonal skills needed to create sexual safety and are generally susceptible to health dangers because of their environments. Therefore, he adds, they often struggle to communicate their needs and possess low motivation to avoid risk. In fact, past studies show 3 to 23 percent of this population is infected with HIV--rates eight to 70 times higher than the general population.
To test whether risk-reduction interventions could decrease behaviors that propel such high rates, Carey and fellow psychologists at the Center for Health and Behavior at Syracuse University randomly assigned 221 female and 187 male participants into one of three conditions. All participants were sexually active, had used alcohol in the past year and were receiving care for mental illnesses at two nonprofit hospitals. Most had been diagnosed with depression, bipolar disorder or schizophrenia. A control group received standard psychiatric care while a second group, the HIV-risk reduction condition, received an intervention program designed to reduce risky sexual behavior.
To see if the HIV-focused intervention would reduce risk compared with other interventions, a third group underwent a structurally equivalent intervention to reduce use of alcohol and other drugs. HIV prevention was discussed to a lesser extent. Both intervention programs consisted of 10 one-hour sessions in which a pair of researchers--one man and one woman--engaged participants in discussion, education and role-play exercises to improve their interpersonal skills, increase their knowledge of risky behavior and enhance their motivation to change. Researchers assessed participants' sexual behavior and substance use immediately before and after the interventions, then again three and six months later.
The researchers found that participants in the HIV-risk reduction group reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safe communication with sexual partners and improved HIV knowledge--even up to six months later. The group focused on substance-use reduction displayed milder improvement on these measures--notably, having fewer sex partners and better attitudes toward condoms--but knew no more about HIV than did the control group.
The results show the value of intervening with psychiatric patients, who are often dismissed as low priorities for health promotion, Carey says. He adds that the best treatment approach might be to include both HIV and substance abuse interventions within overall mental health care.
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