The purpose of this study is to determine whether motivational interviewing and skills
building interventions reduce HIV risk behavior for adults with serious and persistent
Our long-term objective is to reduce the incidence of HIV for people with serious and
persistent mental illness (SMI) by developing an effective primary and secondary HIV risk
reduction intervention for this population which can be easily delivered in the "real world"
settings in which patients routinely receive care. Research findings document that the
incidence of HIV infection, sexually transmitted diseases, and sexual and drug use behaviors
are high among people with serious mental illness, as evidenced by rates of HIV infection
and other sexually-transmitted diseases (STDs). A variety of factors underlie risky
behaviors for the SMI, including cognitive impairment, poor judgment, affective instability
Skills-building (SB) HIV risk reduction interventions, typically delivered in a small group
formats, have had modest success in increasing HIV-related knowledge and improving risk
reduction skills for people with SMI, although these effects are transient. As
skills-building interventions are currently the standard of care in most research and
clinical settings for HIV prevention, it is important to identify new ways to augment these
A relatively new and promising addition to the armamentarium of individualized interventions
is Motivational Interviewing (MI). MI is an approach designed to reduce ambivalence and
enhance intrinsic motivation to change problematic behaviors. Previous researchers have
noted effects for both SB and MI interventions independently, however, these effects tend to
be fairly modest. Integrating these approaches in a systematized way allows us to test the
degree to which this combination is useful, given that both motivation and skills are
clearly important in effecting health behavior change.
Our specific primary aims are the following:
1. To adapt SB and MI interventions for HIV risk reduction for men and women with serious
and persistent mental illness (SMI).
Interventions for HIV risk reduction for people with SMI are typically offered in a
group format and focus primarily on skills-building. We have developed and refined a
brief, individually-tailored skills-building intervention (SB Intervention), based on
these existing manuals. We have also adapted and refined a brief individually-tailored
Motivational Interviewing intervention to target HIV risk behaviors, incorporating
skills-building techniques analogous to those in the SB intervention, resulting in a
Motivational-Interviewing & Skills-Building Intervention (SB-MI Intervention).
Adaptation and refinement of the SB and SB-MI interventions was informed by consulting
with experts in MI, SMI, and HIV risk reduction, eliciting feedback from advisory
boards of providers and consumers, and conducting feedback interviews with participants
who have completed participation in the study.
2. To pilot test and obtain preliminary data with regard to the feasibility of our
interventions and the differences in outcome associated with our SB and SB-MI
interventions for reduction of HIV-related risk behaviors in a cohort of SMI adults.
Comparison of SB and SB-MI interventions in the proposed pilot study will allow us to
assess the degree to which incorporation of motivational techniques are helpful in
augmenting skills-building interventions for HIV risk reduction for people with SMI.
These preliminary analyses will inform our need to refine the adapted interventions (SB
3. To offer HIV counseling and testing for at-risk individuals with SMI, with an emphasis
on connecting participants to appropriate medical and mental health services.
To date, increasing rates of HIV counseling and testing for the SMI has not been a
primary focus of clinical research, which we believe to be a significant public health
deficit. As part of both of our interventions we are providing information about HIV
counseling and testing services to those participants not identified as
HIV-seropositive and encouraging them to access these services. We are then tracking
the degree to which participants follow up on these referrals as part of our follow-up
evaluations. This will allow us to test the degree to which our interventions are
helpful in increasing rates of HIV testing.
4. To begin to explore the relationships between participant characteristics, HIV risk
behaviors, and response to our interventions.
One of the unique features of our intervention is that it assumes an individually-tailored
approach, which can address unique patient characteristics inherent in a heterogeneous
sample. Indeed, using a heterogeneous sample greatly facilitates our primary long-term
objective, which is to develop useable interventions that can be adapted in real-world
settings. This project will allow us to begin to identify those characteristics that are
likely to be associated with more positive outcomes (i.e. greater risk reduction, increased
rates of HIV testing).
- Age 19 and older
- Able to provide consent
- Able to understand and speak English
- Willing and able to participate
- Suffer from a serious and persistent mental illness (SMI)
- Have had at least one HIV risk behavior (unprotected sexual activity, sharing
injection drug needles without following Center for Disease Control guidelines for
needle-cleaning, sexual activity while under the influence of drugs or alcohol)
during the three-month period prior to the baseline evaluation
- Do not suffer from a serious mental illness
- Have not engaged in an HIV risk behavior during the three-month period prior to the
- Unable to provide consent
- Unable to understand and speak English
- Under the age of 19