HIV Prevention for Dual Diagnosed Persons

描述（由申请人提供）：患有严重精神疾病的人接触艾滋病毒的风险不成比例。物质使用，包括许多与注射无关的行为，与传播风险有关。对其他人群的研究表明，减少或改变药物使用可显著影响性危险行为，这表明药物使用应成为艾滋病毒预防工作的主要目标。迄今为止，还缺乏调查针对同时患有物质使用障碍的严重精神疾病患者的物质使用行为的干预措施对性风险行为的影响的研究。因此，本项目建议开展一项lb阶段行为干预试验（Rounsaville et al., 2001），目标是降低双重诊断（严重精神疾病和物质使用障碍）患者的性风险。该项目将分两个阶段进行。第一阶段将致力于发展工作，使用焦点小组来探索干预内容，并制定招募、吸引和留住参与者的程序，包括参加多个干预会议的纵向研究。我们还将制定和试点两项新措施，一项评估药物使用的增量变化，另一项评估对艾滋病毒预防行为的同伴支持。在第二阶段，我们将评估干预方案，随机分配120名符合条件的参与者，男女人数相等，分为三种情况：1)等候名单控制+认知行为性风险降低（CB）；2) CB +健康教育；或3)减少CB +物质使用危害（HR）。在干预后立即和研究开始后24周收集所有参与者的结果数据。主要结果将包括危险性行为（如按伴侣类型和性伴侣数量分列的无保护性交次数）。我们还将收集一些物质使用变量（物质使用、与酒精或药物使用同时发生的性活动以及增量变化）作为性风险变化的中介因素的数据。预计这项工作将导致一项全面疗效研究的提案的发展。

DESCRIPTION (provided by applicant): Persons with severe mental illness are at disproportionate risk for exposure to HIV. Substance use including many non-injection related behaviors, are associated with transmission risk. Research with other populations has demonstrated that reductions or changes in substance use can significantly impact sexual risk behaviors, suggesting that substance use should be a primary target of HIV prevention efforts. To date, there is a dearth of research investigating the impact on sexual risk behaviors on interventions targeting the substance use practices of persons with severe mental illness who also have substance use disorders. This project therefore proposes to conduct a Stage lb behavioral intervention trial (Rounsaville et al., 2001) targeting sexual risk reduction for persons with dual diagnosis (severe mental illness and substance use disorder). This project will be conducted in two phases. Phase one will be devoted to developmental work using focus groups to explore intervention content and developing procedures for recruiting, engaging, and retaining participants in longitudinal research that involves attending multiple intervention sessions. We will also develop and pilot test two new measures, one assessing incremental changes in substance use and another assessing peer support for HIV preventive behaviors. In phase two we will evaluate the intervention programs randomly assigning 120 eligible participants, equal numbers of men and women, to one of three conditions: 1) wait-list control + cognitive-behavioral sexual risk reduction (CB); 2) CB + Health Education (HE); or 3) CB + substance use harm reduction (HR). Outcome data will be collected from all participants at immediate post-intervention and 24 weeks after study entry. Key outcomes will include risky sex (e.g., number of occurrences of unprotected intercourse by partner type and number of sexual partners). We will also collect data on a number of substance-using variables (substance use, sexual activity in conjunction with alcohol or drug use, and incremental change) as mediators of change in sexual risk. It is anticipated that this work will lead to the development of a proposal for a full-scale efficacy' study.