Effective methods to change sex-risk among drug users: a review of psychosocial interventions

doi:10.1016/S0277-9536(02)00557-9

Social Science & Medicine

Volume 57, Issue 9, November 2003, Pages 1593-1608

https://doi.org/10.1016/S0277-9536(02)00557-9 Get rights and content

Abstract

This review examines the current state of knowledge on the effectiveness of HIV prevention interventions with respect to sexual behavior among the population of drug users. The review focuses specifically on the relation between intervention methods found to be effective and the underlying theory.

Electronic searches were conducted and supplemented by publications gathered through other channels. The studies were reviewed for (1) study design, (2) evident use of theory in intervention development, (3) clear targeting of determinants, (4) description of the study or studies, and (5) evaluation of the behavioral goals and targeted determinants.

For each study, a description is given of: (1) the size and nature of the sample; (2) the retention rate; (3) the study design; (4) the nature of the intervention programs, including theoretical methods, practical strategies and theoretical background; (4) the measures of variability.

The results show that a limited number of interventions were effective in changing sexual risk behavior among drug users. More successful programs featured several of the following elements: use of multiple theories and methods, inclusion of peers and rehearsal of skills. Moreover, the community-level interventions showed the importance of sustainability. The most successful intervention methods were modeling, skill building and social support enhancement. These methods are generally derived from the Social-Cognitive Theory or the Diffusion of Innovations Theory.

Future HIV/AIDS interventions should build on the strengths discussed. Evaluations of interventions should be designed to facilitate comparison, using standardized and specific behavioral outcomes as well as standardized and preferably long-term follow-up levels, and should also evaluate the impact of programs at a psychosocial level to examine whether or not the theoretical methods on which a program was based were actually effective in changing the psychosocial factors targeted and why.

Section snippets

Study design

Electronic searches were conducted and supplemented by publications collected through the professional network. The databases we used included Medline, PsycInfo, ERIC and Online Contents. We included studies that (1) were identifiable as psychosocial or behavioral in nature, (2) aimed at a target population that was clearly identifiable as injecting drug users or non-injecting substance-dependent users (e.g., heroin, cocaine, methadone), regardless of whether they were in or out of treatment

Results

A total of 17 studies were included in the review. Six studies involved individual interventions (see Table 2), two of these being derived from the article by Gibson, Lovelle Drache, Young, Hudes, and Sorenson (1999). Eight studies could be characterized as group interventions (see Table 3), with two derived from the same article (Sorenson et al., 1994). Finally, three studies were identified as community-level interventions (see Table 4). The results are presented as follows. The studies have

Discussion

The present review divided the studies found into three categories: individual interventions, group interventions and community-level interventions. Overall, we found that of the 17 studies reported, only five (Jamner et al., 1997; McCoy et al., 1998; Rietmeijer et al., 1996) found changes in sexual behavior (self-reported condom use, number of different sex partners) or condom use skills (Malow et al., 1994; Sorenson et al., 1994) among the experimental group that were significantly different

Conclusion

In recent years, more attention has been paid to the sex life of drug users, and several theory- and evidence-based interventions have been developed to address this issue. Although there are a number of limitations in the studies reviewed, it is clear that evaluation designs have improved. It has been shown that behavioral interventions can be effective in reducing unsafe sexual behavior among drug users, although the present review makes it clear there is a need for further improvement. As

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Effective methods to change sex-risk among drug users: a review of psychosocial interventions

Abstract

Section snippets

Study design

Results

Discussion

Conclusion

Decision Processes

Drug and Alcohol Dependence

Evaluation and Program Planning

Journal of Adolescent Health

Journal of Adolescent Health

Effect of a nursing outreach intervention to drug users in Detroit, Michigan

Journal of Drug Issues

Evaluation of a cognitive behavioural intervention for HIV prevention among injecting drug users

AIDS

Social foundations of thought and action

Intervention mappingDesigning theory- and evidence-based health promotion programs

Intervention MappingA process for developing theory- and evidence-based health education programs

Health Education and Behavior

The health belief model and personal health behavior

Health Education Monographs

How effective are risk-reduction intervention targeting injecting drug users?

AIDS

Predicting increased condom use with steady partnersPotential approaches for intervention

Drugs and Society

HIV risk in intravenous drug users and crack cocaine smokersPredicting stages of change for condom use

Journal of Consulting and Clinical Psychology

Towards an understanding of risk behaviorAn AIDS risk reduction model (ARRM)

Health Education Quarterly

Prevention of HIV infection

AIDS

Using the theory of planned behavior to predict intention to use condoms among male and female injecting drug users

Journal of Applied Social Psychology

Peer-delivered interventions reduce HIV risk behaviors among out-of-treatment drug abusers

Public Health Reports

Outreach-based HIV prevention for injecting drug usersA review of published outcome data

Public Health Reports

The effectiveness of educational and needle exchange programsA meta-analysis of HIV prevention strategies for injecting drug users

Quality and Quantity

Problem-solving therapies

Skills building and social support enhancement to reduce HIV risk among women in jail

Criminal Justice and Behavior

Preventing HIV/AIDS in drug-abusing incarcerated women through skills building and social support enhancementPreliminary outcomes

Social Work Research

HIV infection among drug users and the potential for heterosexual spread

Belief, attitude, intention and behaviorAn introduction to theory and research

The role of psychosocial factors in HIV reduction among gay and bisexual menA quantitative review

Psychology and Health

Social intervention against AIDS among injecting drug users

British Journal of Addiction

Effectiveness of brief counseling in reducing HIV risk behavior in injecting drug usersFinal results of randomized trials of counseling with and without HIV testing

AIDS and Behavior

Effectiveness of psychosocial interventions in preventing HIV risk behaviour in injecting drug users

AIDS

Social networks and social support

Evidence for the effects of HIV antibody counseling and testing on behaviors

JAMA

Determinants of safe sex and risk-taking behavior among gay menA review

AIDS Education and Prevention

Impact of longitudinal community HIV intervention targeting injecting drug users’ stage of change for condom and bleach use

American Journal of Public Health

HIV behavioral interventions for adolescents in community settings

Recent HIV-prevention interventions for gay menIndividual, small-group and community-based studies

AIDS