HIV RISK REDUCTION INTERVENTIONS FOR PERSONS WITH SEVERE MENTAL-ILLNESS

Recent seroprevalence studies have shown alarming rates of HIV infecti on among severely mentally ill men and women in large urban areas, and HIV behavioral epidemiology research indicates that a substantial pro portion of seriously mentally ill adults engage in activities that inc rease their vulnerability to HIV/AIDS. In this paper the research lite rature on HIV prevention interventions is reviewed including reports t hat have described HIV prevention programs, studies that have used unc ontrolled pre- and postintervention methods to evaluate risk reduction interventions, and those that have used rigorous randomized designs a nd examined risk behavior change. Collectively, these studies show tha t intensive, small-group interventions that target a variety of risk-r elated dimensions - including knowledge, attitudes, and motivations, a nd behavioral and cognitive skills - can produce at least short-term r eductions in high-risk sexual behavior among the severely mentally ill . A number of gaps in the research literature are identified including the need to: (a) better tailor interventions to risk situations encou ntered by the mentally ill; (b) develop gender-tailored interventions; (c) examine and implement HIV prevention programs so they help person s sustain behavior change; (d) explore one-on-one counseling and commu nity-level intervention methods; and (e) develop risk reduction interv entions for already-seropositive individuals. implications for service provision are discussed. (C) 1997 Elsevier Science Ltd.