mental health AIDS

Fall 2004 Newsletter / Volume 6, Issue 1

HIV Prevention News

Over a six-month period, Longshore, Stein, and Conner (2004) followed 294 HIV-negative injecting drug users (IDUs) receiving drug treatment and found that the intention to reduce risk as well as continuous participation in treatment were associated with a reduction in injection risk behavior. In addition, greater self-efficacy, less risk behavior at baseline, less perceived susceptibility to infection with HIV, and greater fear of AIDS were also associated with the intention to reduce risk. The authors suggest that

HIV risk intervention in drug treatment settings should focus on raising the client's intention or conscious commitment to risk reduction while also imparting skills and confidence for risk reduction.. .. Strategies to address intentions and self-efficacy include exercises to promote the cognitive"accessibility". .. of risk reduction skills as well as intentions and goal-setting exercises. .. in which a person declares both the acquisition of specific skills and the adoption of specific commitments as his/her intervention objectives. (pp. 362-363)

Longshore and colleagues further submit that it is"crucial to assess the client's perceived susceptibility based on his/her own behavior and, even more important, to see whether perceived susceptibility contributes to ongoing risk behavior by inducing unrealistic optimism regarding infection risk. .. or through debilitating pessimism regarding that risk. Interventions may be considerably more effective if tailored to the client's perceived susceptibility in this way" (p. 363).

With regard to"fear appeals," which are generally thought to undermine risk reduction, such appeals, in the view of these authors,

can have favorable effects if closely paired with information on how to avoid risk. .. [and may] be productive in a treatment context [italics added]. However, treatment-based intervention efforts should. .. be careful not to"turn up the volume too high". .. when delivering information on the risk of behaviors in which clients are known to have engaged, should carefully gauge each client's emotional response to threat-related material, and should include content designed to overcome possible denial or other defensive responses to fear. .. (p. 364)

Turning to sexual risk, French investigators (Vincent et al., 2004) studied 192 IDUs receiving highly active antiretroviral therapy (HAART) who reported one or more experiences of sexual behavior with an"occasional" partner over a seven-year period and found (when controlling for co-factors such as injecting drug status, number of partners, and frequency of sexual intercourse) that unprotected sex was associated with the presence of three or more non-lipodystrophy HAART-related side effects."Our study. .. suggests that HIV patients' perception of HAART-related side effects may be of importance beyond that of strict clinical relevance. Clinicians should allow for patient's self-perceived side effects when counselling on secondary prevention. This study also indicates that injection prevention should not be dissociated from the management of HAART toxicity when addressing sexual risk taking issues among HIV-infected IDU[s]" (p. 1324).

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