MED Study: Mentally Ill at High HIV Risk
$2.8 million federal grant for motivational counseling
Armed with a five-year, $2.8 million federal grant, School of Medicine researchers are hoping to stem HIV infection and transmission among mentally ill people engaged in risky behaviors such as needle sharing and unprotected sex.
Applying a technique called motivational interviewing (MI), the BU team, from the Mental Health Counseling and Behavioral Medicine Program (MHCBM), will recruit and counsel severely mentally ill adults who want to protect themselves from HIV or who are already infected but don’t want to pass the disease to others. Sometimes homeless, these people lack the confidence, self-control, and communication skills to change their behavior. By tailoring sessions to the individual, MI counselors give people unsparing information about the potential price of their risky behavior and help them build skills to change that behavior, says Stephen Brady, a MED associate professor of psychiatry and graduate medical sciences and MHCBM director. The study, funded by the National Institute of Mental Health, will include 308 volunteers and will compare brief MI-based prevention treatment with what clinicians call “care as usual.”
Participants will be recruited through advertisements posted at homeless shelters, emergency rooms, housing for the mentally ill, and other care centers, and will represent people living with a range of mental illnesses, including schizophrenia, major depression, bipolar disorder, and severe anxiety disorders like post-traumatic stress disorder. What they have in common, along with intravenous drug users in the study, is their greatly increased risk of acquiring or passing along HIV.
Brady and his colleagues will measure MI’s effects in sessions 3, 6, and 12 months after the interventions. If results are as promising as those of a much smaller pilot study completed by the BU team in 2009, says Brady, the model could be adapted to a range of settings and providers.
Although MI was first described in 1983, the method has sparked a lot of interest recently, according to Brady. More goal-oriented than many talk therapies, MI seeks to change behavior by helping people explore and resolve their ambivalence, rather than trying directly to persuade them to stop doing things that can harm them. “We give them feedback about their risk behavior, tell them what the odds are they will contract HIV; we have them pick areas that are most difficult to change, and we work on skills such as condom or barrier use, or de-linking the use of alcohol or drugs with having sex,” says Brady, whose clinic also offers HIV testing and care referrals for research subjects who want them.
Why target the seriously mentally ill in an HIV/AIDS study? In a review of 52 studies, Brady found that the majority of adults with serious mental illness are sexually active. Of these, many engage in high-risk behavior, which is most prevalent among the homeless. The review found that nearly half of the people in the studies had multiple partners and never used condoms, while a quarter had a history of prostitution or sex trading, and 30 percent had had at least one sexually transmitted disease. And 20 percent of the seriously mentally ill in the studies had histories of IV drug use.
“What we do is primary prevention,” Brady says, “to prevent people who don’t have HIV from getting it, and secondary, preventing those who are HIV-positive from spreading it.”
“Most people with mental illness are aware of HIV testing,” he says. “They want to know their HIV status, and testing has become very common among this population, but we also know that instead of reducing risk, they just keep getting tested. They assume they’ll continue to test negative, not understanding that they’ve just been lucky so far.” Brady believes high-risk behavior among the mentally ill is a motivation problem. “Most behavioral science research is very static,” its strategy applied across the board, he says. “But the package we offer is very focused on the individual patient and what he or she wants to do. We can help people with their thinking and planning, from saying no to negotiating safer sex.” For example, he says, female condoms are expensive, but the women who begin using them soon feel empowered.
When Brady first began his research, people in the field told him that his approach would never work. “Predictions were that the clients would all wind up with HIV,” he says. “But my experience is, these people don’t want to get HIV and they don’t want to give it to people. They just face so many obstacles — where to sleep, drug addictions, using their bodies to get what they want. But this doesn’t mean people can’t be motivated to use condoms, have periodic visits with an ob-gyn,” or stop sharing needles.
Susan Seligson can be reached at email@example.com Comments