Primary prevention of HIV in persons with severe mental illness; A case manager delivered intervention

Background: Persons with severe mental illness (SMI) who abuse substances are at least three to seven times more likely to be infected with HIV compared with other Medicaid recipients. Case managers are primary providers of service to this population and are in a unique position to intervene. We translated two HIV prevention programs proven effective in the general population to develop Preventing AIDS Through Health (PATH). This RCT examined the hypothesis that individuals with SMI receiving PATH will report fewer high-risk sexual behaviors, substance use related behaviors and have improved condom use skills, and use less substances. Methods: Two hundred and eighty adults with SMI participated in a cluster randomized design where eighteen case managers delivered the PATH manualized program to their respective caseloads and nineteen case managers delivered usual care. Individuals were interviewed at baseline, three, six and twelve months. Measures encompassed use of drugs and alcohol, condom-use skills, symptoms of mental illness and sexual risk- taking behaviors. Results: Experimental participants reported using condoms more frequently at six months and had better condom use skills at 12 months. Conclusions: The PATH intervention was effective in reducing HIV risk behaviors related to increased condom use and improvement in condom use skills. Case managers are capable of effectively delivering the intervention and their clients have the capacity to learn and adopt new risk reduction behaviors to protect themselves against HIV. Implications for working with this high-risk population will be discussed.