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Copenhaver et al. (2006)
conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate behavioral HIV risk reduction interventions targeting people who inject drugs. ... [The investigators] included 37 RCTs [available as of March 30, 2004] evaluating 49 independent HIV risk reduction interventions with 10,190 participants. Compared to controls, intervention participants reduced [both] injection drug use (IDU) and … [the use of noninjected drugs], increased drug treatment entry, increased condom use, and decreased trading sex for drugs. Interventions were more successful at reducing IDU when participants were non-Caucasians, when content focused equivalently on drug-related and sex-related risks, and when content included interpersonal skills training specific for safer needle use. Condom use outcomes improved when two intervention facilitators were used instead of one. IDU outcomes did not decay, but condom use outcomes did. Behavioral interventions reduce risk behaviors among people who inject drugs, especially when interventions target both drug risk and sexual risk behaviors, and when they include certain behavioral skills components. (p. 163)
With regard to the decay in condom use outcomes, Copenhaver and colleagues suggest that "[m]aintaining consistent condom use may require additional strategies (e.g., booster sessions) to address emergent challenges …" (p. 170).
Margolin, Beitel, Schuman-Olivier, and Avants (2006) conducted a controlled study involving 72 methadone-maintained clients who were assigned either to standard care plus 8 weeks of Spiritual Self-Schema (3-S) therapy, or to standard care alone. 3-S therapy "is a manual-guided intervention for increasing motivation for HIV prevention that integrates a cognitive model of self within a Buddhist framework suitable for people of all faiths" (p. 311).
3-S therapy is based on ... [the supposition] that addicted individuals can develop, elaborate, and make available for habitual activation, a self-schema that is incompatible with causing harm – the spiritual self-schema – which will provide them with rapid access to the repertoire of HIV preventive behaviors that they are taught ... in their HIV educational sessions. It is ... a basic goal of 3-S therapy to weaken the addict self-schema and strengthen a spiritual self-schema that is incompatible with causing harm to self or others, so when clients find themselves in high-risk situations, a sequence of behavior is set into motion that leads to HIV preventive behavior rather than to high risk behavior. (p. 313)
Margolin and colleagues found 3-S therapy
to be efficacious with respect to achieving its intended goal of increasing motivation for HIV preventive behavior among drug users. It also had the added effect of changing actual HIV risk behavior. Clients receiving 3-S therapy were eight times less likely to have engaged in HIV risk behavior posttreatment, controlling not only for pretreatment risk behavior but also for demographic and drug use variables. Correlational analysis supported the hypothesized relation between spiritual practices and motivation for HIV prevention. This analysis also showed that attendance at 3-S therapy sessions was significantly related not only to increased spiritual practice but also to HIV prevention motivation and behavior. (p. 320)
Swiss investigators (Brodbeck, Matter, & Moggi, 2006) conducted computer-assisted telephone interviews with a random sample of 2,790 heterosexual men and women between the ages of 16 and 24 years to examine the association between cannabis use and sexual risk behavior. Importantly,
the results of this study found only a general association between substance use and unprotected sexual intercourse that could not be found in event-level analyses. The situational influence of cannabis did not increase sexual risk behavior among young men and women. Cannabis users, however, had decreased intentions to use HIV protection, lower self-efficacy, and a more hedonistic and risky lifestyle, leading to more frequent risky sexual behavior. Thus, the target variables for HIV prevention do not seem to differ for young adults using or not using cannabis. ... Complementary to this, risk preference and hedonism as an underlying risk disposition for cannabis use and sexual risk behavior might be addressed in interventions for enhancing risk competence and the choosing of exciting activities with less harm potential. (p. 604)
Additionally, Brodbeck and colleagues argue that "HIV interventions that include a message on substance use should be careful not to create strong expectancies that substance use leads to sexual risk behavior, for this could promote a self-fulfilling prophecy and have the effect of giving people an excuse for engaging in unprotected sex ..." (p. 604).
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Winter 2007 Newsletter / Volume 8, Issue 2
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