Abstract
Research on behavioral HIV risk reduction interventions for injection drug users (IDUs) has focused on primary outcomes (e.g., reduced injection drug use, increased condom use) but has not fully examined the respective roles played by intervention components on these primary outcomes. In this paper, we present a structural equation modeling (SEM) approach in which we specify the causal pathways leading from theory-based intervention components to risk reduction outcomes among a sample of primarily IDUs (n = 226) participating in an inner-city community-based methadone maintenance program. Similar pathways were found leading to both drug- and sexual-related risk reduction outcomes. Findings suggest the importance of targeting participants' risk reduction motivation and behavioral skills versus employing more passive informational strategies. Findings also indicate that our intervention may be optimized by focusing more on participants' risk reduction motivation within the sexual-related content and placing equivalent emphasis on participants' risk reduction knowledge, motivation, and behavioral skills within the drug-related content. By quantifying the specific linkage between intervention components and risk reduction outcomes, our SEM findings offer empirical guidance for optimizing this intervention. This strategy may also serve as a useful theory- and data-driven means to inform the refinement of other behavioral interventions.
Similar content being viewed by others
Notes
Standardized correlation coefficients (with unstandardized correlation coefficients in parentheses).
References
Centers for Disease Control and Prevention 2004. Special! Data Request. Available at: http://www.statehealthfacts.kff.org. Accessed August 18, 2004.
Joint United Nations Programme on HIV/AIDS. Q&A II: basic facts about the AIDS epidemic and its impact, UNAIDS questions and answers. UNAIDS; 2004. Available at: http://www.unaids.org. Accessed August 19, 2004.
Avants SK, Margolin A, Usubiaga MH, Doebrick C. Targeting HIV-related outcomes with intravenous drug users maintained on methadone: a randomized clinical trial of a harm reduction group therapy. J Subst Abuse Treat. 2004;26:67–78.
Margolin A, Avants SK, Warburton LA, Hawkins KA, Shi J. A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users. Health Psychol. 1997;22:223–228.
Semaan S, Des Jarlais DC, Sogolow E, et al. A meta-analysis of the effect of HIV prevention interventions on the sex behaviors of drug users in the United States. J Acquir Immune Defic Syndr. 2002;30:S73–S93.
Strathdee SA, Hogg RS, Martindale SL, et al. Determinants of sexual risk-taking among young HIV-negative gay men. J Acquir Immune Defic Syndr. 1998;19:61–66.
Vlahov D, Junge B, Brookmeyer R, et al. Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program. J Acquir Immune Defic Syndr. 1997;16:400–406.
Coyle SL, Needle RH, Normand J. Outreach-based HIV prevention for injecting drug users: a review of published outcome data. Pub Health Rep. 1998;113(Suppl. 1):19–30.
Himmelgreen DA, Singer M. HIV, AIDS, and other health risks: findings from a multisite study—an introduction. Am J Drug Alcohol Abuse. 1998;24:187–197.
Kotranski L, Semaan S, Collier K, Lauby J, Halbert J, Feighan K. Effectiveness of an HIV risk reduction counseling intervention for out-of-treatment drug users. AIDS Educ Prev. 1988;10:19–33.
Reikowski DJ. A Behavioral and Cognitive Intervention for AIDS Prevention [dissertation]. Stanford, CA: Stanford University; 1994.
Malow RM, West JA, Corrigan SA, Pena JM, Cunningham SC. Outcome of psychoeducation for HIV risk reduction. AIDS Educ Prev. 1994;6:113–125.
Baker A, Heather N, Wodak A, Dixon J, Holt P. Evaluation of a cognitive–behavioural intervention for HIV prevention among injecting drug users. AIDS. 1993;7:247–256.
Calsyn DA, Saxon AJ, Freeman, G Jr., Whittaker S. Ineffectiveness of AIDS education and HIV antibody testing in reducing high-risk behaviors among injection drug users. Am J Publ Health. 1992;82:573–575.
Copenhaver M, Johnson BT, Lee IC, Harman J, Carey M. HIV risk reduction among people who inject drugs: meta-analytic evidence of efficacy. J Subst Abuse Treat. In press 2006.
Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111:455–474.
Fisher WA, Fisher JD, Harman J. The information–motivation–behavioral skills model: a general social psychological approach to understanding and promoting health behavior. In: Suls J, Wallston KA, eds. Social Psychological Foundations of Health and Illness. Malden, Massachusetts: Blackwell; 2003:82–106.
Fisher JD, Fisher WA. The information–motivation–behavioral skills model. In: DiClemente R, Crosby R, Kegler M, eds. Emerging Theories in Health Promotion Practice and Research. San Francisco, California: Jossey-Bass; 2002:40–70.
Hammer J, Fisher JD, Fisher WA. When two heads aren't better than one: AIDS risk behavior in college couples. J Appl Soc Psychol. 1996;26:375–397.
Misovich SJ, Fisher JD, Fisher WA. The perceived AIDS-preventive utility of knowing one's partner well: a public health dictum and individuals' risky sexual behavior. Can J Hum Sex. 1996;5:83–90.
Fishbein M, Ajzen I. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Reading, Massachusetts: Addison-Wesley; 1975.
Bandura A. Perceived self-efficacy in the exercise of control over AIDS infection. In: Mays VM, Albee GW, Schneider SM, eds. Primary Prevention of AIDS. Newbury Park, California: Sage; 1989:128–141.
Bandura A. Social cognitive theory and exercise of control over HIV infection. In: DiClemente RJ, Peterson JL, eds. Preventing AIDS: Theories and Methods of Behavioral Interventions. New York, New York: Plenum; 1994:25–59.
Kelly JA, St. Lawrence JS. AIDS prevention and treatment: psychology's role in the health crisis. Clin Psychol Rev. 1988;8:255–284.
Fisher JD, Fisher WA, Williams SS, Malloy TE. Empirical tests of on information–motivation–behavioral skills model of AIDS preventive behavior. Health Psychol. 1994;13:238–250.
Copenhaver M, Lee I, Margolin A. Successfully integrating an HIV risk reduction intervention into a community-based substance abuse treatment program. Am J Drug Alcohol Abuse. In press 2006.
Centers for Disease Control and Prevention. Cases of HIV infection and AIDS in the United States. HIV/AIDS Surveillance Report. Atlanta, Georgia: US Department of Health and Human Services, CDC; 2003.
Metzger D, Woody GE, Navaline H, et al. The Risk Assessment Battery (RAB): validity and reliability. Presented at: The Sixth Annual Meeting of National Cooperative Vaccine Development Group for AIDS; October 30-November 4, 1993; Alexandria, Virginia.
Fisher JD, Cornman DH, Osborn CY, Amico KR, Fisher WA, Friedland GA. Clinician-initiated HIV risk reduction intervention for HIV-positive persons: formative research, acceptability, and fidelity of the OPTIONS project. J Acquir Immune Defic Syndr. 2004;37:S78–S87.
Albarracín D. A test of major assumptions about behavior change: a comprehensive look at HIV prevention since the beginning of the epidemic. Paper presented at: The Center for Health/HIV Intervention and Prevention (CHIP), University of Connecticut; 2004; Storrs, Connecticut.
Metzger DS, Navaline H, Woody G. Drug abuse treatment as AIDS prevention. Pub Health Rep. 1998;113:97–106.
Pigott TD. Missing predictors in models of effect size. Eval Health Prof. 2001;24:277–307.
Avants SK, Warburton LA, Hawkins KA, Margolin A. Continuation of high-risk behavior by HIV-positive drug users: treatment implications. J Subst Abuse Treat. 2001;19(1):15–22.
Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47:1102–1114.
Copenhaver M, Fisher JD. Experts outline ways to decrease the decade-long yearly rate of 40,000 new HIV infections in the U.S. AIDS Behav. In press DOI 10.1007/s10461-005-9034-x 2006.
Acknowledgement
Funding to support this study was provided by the Connecticut Department of Public Health—AIDS Division (DPH Log #2004-154) to Michael M. Copenhaver. Funding to support data analyses and preparation of this manuscript was provided by the National Institute on Drug Abuse, grant K23-DA017015 to Michael M. Copenhaver.
Author information
Authors and Affiliations
Corresponding author
Additional information
Copenhaver and Lee are with the Department of Psychology, Center for Health/HIV Intervention & Prevention (CHIP), University of Connecticut, 2006 Hillside Drive, Unit 1248, Storrs, CT 06269, USA.
Rights and permissions
About this article
Cite this article
Copenhaver, M.M., Lee, IC. Optimizing a Community-Friendly HIV Risk Reduction Intervention for Injection Drug Users in Treatment: A Structural Equation Modeling Approach. J Urban Health 83, 1132–1142 (2006). https://doi.org/10.1007/s11524-006-9090-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11524-006-9090-1