HUMAN-IMMUNODEFICIENCY-VIRUS SEXUAL RISK REDUCTION IN HOMELESS MEN WITH MENTAL-ILLNESS

Background: The spread of human immunodeficiency virus infection to im paired groups has intensified the challenge for its prevention; contro l of the epidemic now requires behavioral change among persons with li mited ability to sustain attention and learn. In this randomized clini cal trial, we tested an intervention to reduce sexual risk behaviors a mong homeless men with severe mental illness. Methods: Men were recrui ted from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chr onic psychotic disorder and a comorbid substance use disorder. Partici pants were assigned to a 15-session experimental group intervention or to a 2-session control intervention and observed for 18 months. The 5 9 participants sexually active before the trial were the main target o f the intervention. Sexual risk behavior was the primary outcome. Resu lts: Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-moonth follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk i ndex for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P=.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up. Conclusion s: This intervention successfully reduced sexual risk behaviors of hom eless men with mental illness. The effect diminished over 18 months bu t did not disappear. Similar approaches may be effective in other impa ired high-risk groups.