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，包括许多非注射相关的行为，都与传播风险有关。对其他人群的研究表明，减少或改变药物使用可以显著影响性危险行为，这表明药物使用应该是艾滋病毒预防工作的主要目标。到目前为止，缺乏针对严重精神疾病患者的药物使用行为的干预措施对性危险行为的影响的研究，这些人也有药物使用障碍。因此，该项目建议进行Lb阶段行为干预试验(Rounaville等人，2001年)，目标是为双重诊断(严重精神疾病和药物使用障碍)的人减少性风险。该项目将分两个阶段进行。第一阶段将致力于发展工作，利用焦点小组探索干预内容，并制定程序，以招募、吸引和留住纵向研究的参与者，包括参加多个干预会议。我们还将制定和试行两项新措施，一项评估物质使用的增量变化，另一项评估同伴对艾滋病毒预防行为的支持。在第二阶段，我们将对干预计划进行评估，将120名符合条件的参与者随机分配到三种情况之一：1)等待名单控制+认知-行为性行为风险降低(CB)；2)CB+健康教育(HE)；或3)CB+物质使用伤害减少(HR)。结果数据将在干预后立即和研究开始后24周从所有参与者那里收集。关键结果将包括有风险的性行为(例如，按伴侣类型和性伴侣数量分列的无保护性行为发生次数)。我们还将收集一些物质使用变量(物质使用、结合酒精或药物使用的性行为以及增量变化)的数据，作为性风险变化的中介。预计这项工作将导致制定一项全面疗效研究的建议。

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.