EFFECTIVENESS OF PSYCHOSOCIAL INTERVENTIONS IN PREVENTING HIV RISK BEHAVIOR IN INJECTING DRUG-USERS

Objective: To consider evidence for the effectiveness of psychosocial interventions in reducing the risk of infection with HIV of injecting drug users. Method: We reviewed 19 published studies of the effectiven ess of individual counselling, HIV testing, group interventions, stree t outreach, and a `social' intervention designed to change norms for s afer behaviours. Results: Eight of 15 studies that examined behavioura l outcomes provided evidence of the effectiveness of an experimental i ntervention, compared with a control or comparison group. In four of t hese studies, however, serious design limitations made results difficu lt to interpret. In the other four studies without design limitations, the success of the experimental interventions may have been due to th eir greater length and intensity as well as to having been conducted w ith stable and well-motivated populations. Nine of the 15 studies show ed evidence of marked behaviourial changes in both experimental and co mparison group(s), with the changes in many cases being sustained for upwards of 12 months. Conclusions: A close examination of the evidence and competing hypotheses for the pattern of results suggests that par ticipating in evaluation research may itself be a valuable interventio n. Implications for the development of interventions include the poten tial efficacy of health risk assessment. Implications for evaluation o f interventions include the need for developing unobtrusive measures a nd for assessing the impact of behavioural assessments. Despite the la rge behavioural changes reported in most of the studies, a substantial proportion of subjects receiving interventions reported unacceptably high levels of risk behaviours. New, more potent interventions are nee ded, such as those designed to change the norms of entire communities of drug users concerning safer injection and safer sex. (C) 1998 Lippi ncott-Raven Publishers.