Integrated HIV care: HIV risk outcomes of pregnant substance abusers

Identifying contextual factors that may influence the effects of HIV risk-reduction strategies aimed at inner-city, minority female populations may be critical to interrupting the alarming trends in seroprevalence in the United States, especially among pregnant women with substance use-related problems. The objective of this Phase I, NIDA-funded project was to determine which contextual and cognitive factors were most predictive of HIV outcomes in this population. Eighty-one HIV-negative women were enrolled in a maternal addiction program with a cognitive-behavioral HIV risk-reduction component. Measures were administered between 1996 and 1998, one week post-admission, and follow-up assessments were conducted on 69 participants at 6 months post-discharge Paired t-tests were conducted to assess changes in sex risk behaviors, HIV/AIDS-related knowledge, and HIV risk-related attitudes/behaviors. Hierarchical regression analyses were conducted to investigate the relationship between attitudes/knowledge with contextual variables. At six months follow-up, there were significant increases in favorable condom attitudes (t = 3.36, p = .01) and in factual knowledge regarding HIV (t = 3.20, p = .01), with a significant decrease in the number of sexual partners (t = 2.21, p = .05). Hierarchical regression analysis revealed that the strongest predictors of the number of partners--a key outcome variable--were alcohol use, intentions to engage in safer sex behaviors, psychiatric symptoms, and a history of physical abuse (F[11, 57] = 6.58, p < .001). This study also reinforces the strategic importance of utilizing substance user treatment programs as crucial vehicles for integrating HIV risk-reduction strategies. Additionally, it will further guide the design of effective procedures to test the feasibility of an integrated HIV risk-reduction intervention for a larger randomized controlled study. The study's limitations are noted.