Effects of a cognitive-behavioral HIV prevention intervention among HIV negative male substance abusers in VA residential treatment

This investigation compared the effectiveness of a cognitive-behavioral HIV risk reduction intervention with a standard care (SC) comparison condition in modifying HIV risk related knowledge, beliefs, attitudes, and behavior at 6-month and 12-month follow-ups among 149 HIV seronegative males. The tw o intervention conditions were administered while participants were in inpa tient alcohol and other drug abuse treatment. Global drug abuse severity, a s well as injection drug abuse, decreased significantly from preinterventio n to follow-up across conditions. There were significant increases in the p roportions reporting sexual activity and increases in levels of unprotected sex acts between baseline and follow-up across conditions. However, no cha nges in sex risk behavior were found among those who reported sexual activi ty both prior to and after intervention across conditions. Participants rev ealed relatively adequate knowledge regarding HIV and HIV risk reduction pr actices, strong belief in the utility of safer practices and in their abili ty to enact such practices, and relatively strong commitment to practice sa fer sex across conditions at baseline assessment. In general, substantial p ostintervention improvements over baseline levels in these areas were not f ound. Relatively modest changes in sexual self-efficacy and in safe-sex gui delines were identified in analyses involving the total sample. Exploratory subgroup analysis suggested increases in knowledge and reductions in susce ptibility and anxiety among those who reported sexual activity both prior t o and after intervention. Among participants reporting initiation of sexual activity after intervention, those receiving SC revealed changes in percei ved susceptibility and in condom attitudes. A discussion is presented of ch allenges associated with providing meaningful HIV risk reduction interventi on when baseline levels of sex risk behavior, perceived HIV infection susce ptibility, and HN anxiety are only moderate and when initial levels of sexu al self-efficacy and commitment are relatively high.