REDUCTION IN RISK BEHAVIOR AMONG ADULTS WITH SEVERE MENTAL-ILLNESS WHO LEARNED TO ADVOCATE FOR HIV PREVENTION

Objectives: The study evaluated the relative impact of HIV risk reduct ion interventions for adults with severe mental illness living in the inner city. Methods:: A total of 104 chronically mentally ill men and women were interviewed to determine sexual risk behavior over the past month and to assess HIV risk-related psychological characteristics, i ncluding their knowledge about risk behavior, their belief in their ab ility to change their behavior, their perceptions of peer and social n orms about safer sex, their expectancies about the outcomes of these c hanges, and their perceived barriers to condom use. Participants were then randomly assigned to one of three conditions: a single AIDS educa tion session, a seven-session cognitive-behavioral HIV risk reduction group intervention, or a seven-session group intervention that combine d the cognitive-behavioral intervention with training to act as a risk reduction advocate to friends (advocacy training). Individuals were r einterviewed three months after completion of the intervention, Result s: Although all participants exhibited change at follow-up in some ris k-related psychological characteristics and sexual risk behaviors, par ticipants who received the cognitive-behavioral intervention that incl uded the advocacy training reported greater reductions in rates of unp rotected sex and had fewer sexual partners at follow-up. Conclusions: HIV prevention interventions that teach risk reduction skills and then encourage participants to advocate behavior change to others appear t o strengthen participants' capacity to change their behavior to reduce HIV risk, even those from a disenfranchised group such as severely me ntally ill adults.