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Belief clusters among HIV-seroconverting drug users: implications for counseling.
Harrison C; Marmor M; Titus S; Cord-Cruz E; Des Jarlais DC; NYU Medical
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(1):184 (abstract no. Mo.D.1756). Unique

Objectives: (1) To describe the beliefs and self-perceived risks held by HIV-seroconverting drug injectors both before and after HIV infection. (2) To identify limitations in the current risk reduction counseling protocols. Methods: An HIV vaccine feasibility study conducted during July 1992 - March 1995 recruited 366 drug injectors and 211 sexual partners of drug injectors or known HIV-positives at 3 methadone maintenance treatment programs and at an out-of-treatment site in New York City. All subjects were asked to assess their risk of being exposed to the HIV virus in the succeeding six months. Any self-assessments that seemed unrealistic to the HIV counselors were discussed in depth and attempts were made to guide the participant toward a more realistic evaluation. Participants were then counseled according to the standard CDC risk reduction protocol. Intensive unstructured interviews were conducted with subjects who seroconverted after their first HIV-positive test result. Results: 11 seroconversions occurred, all among individuals who had injected drugs or had sex with partners known to be infected in the previous 6 months. The 11 seroconverters decreased their injection frequencies less than drug injectors who remained HIV seronegative. At pre-seroconversion interviews, 8 of the 11 HIV-seroconverters felt they were "unlikely" or only somewhat likely" to become exposed to HIV. All 8 expressed a belief that they were somehow "immune" to HIV because they had taken substantial risks in the past and remained uninfected. 3 subjects who felt they were "very likely" to become infected nonetheless did not reduce risk behaviors. 7 of the 11 seroconverters had life situations that may have made it especially difficult to change behavior (2 were commercial sex workers, 2 were unstably domiciled and 3 were in sexual relationships with known HIV-positive partners). Conclusions: Our HIV counseling failed to alter the beliefs or the behaviors of subjects who subsequently seroconverted. Individually tailored counseling based on personalized assessments dealing with specific life situations and beliefs, and referral of some patients for intensive, prolonged interventions may be necessary and costeffective in preventing HIV infection among those at greatest risk.

*Counseling *HIV Seropositivity/THERAPY *Substance Abuse, Intravenous