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A number of studies have established high human immunodeficiency virus (HIV) seroprevalence among severely mentally ill men and women living in large urban areas. Much less research has characterized the patterns of risk behavior that contribute to elevated vulnerability to HIV/AIDS among the mentally ill, as well as psychological, situational, and gender-related influences on risk in this population. One-hundred thirty-four severely mentally ill men and women who reported sexual activity outside of an exclusive relationship or with high-risk partners completed an extensive measure battery concerning HIV risk. Knowledge about HIV was low and sexual risk behavior levels were high in the sample. On average, condoms were used in only 32% of intercourse occasions in the past three months, and nearly one-half of participants reported multiple sexual partners in the same period. Patterns common in the sample were sex associated with substance use; coerced sex, bartering sex for money, food, clothes, or a place to stay; and sex with injection drug user partners. Factors predictive of greater risk were being female, presently being in a relationship, perceiving oneself to be at risk, high levels of alcohol use, and weak risk reduction behavioral intentions. Mental health programs serving severely mentally ill men and women are reaching a population at elevated risk for contracting HIV infection, and can serve as a venue for targeted HIV prevention interventions. [ABSTRACT FROM AUTHOR]

HIV prevalence is alarmingly high among persons with serious mental illness and severely mentally ill adults frequently engage in high-risk behavior practices. This study evaluated the effectiveness of a small-group HIV risk reduction intervention offered to 189 men and women in outpatient programs for severely mentally ill adults. Participants screened for HIV risk were randomly assigned to attend either a 7-session small-group cognitive-behavioral HIV risk reduction intervention or a time-matched comparison intervention and were followed at 3-month intervals for one year. Participants who attended the HIV risk reduction intervention increased their condom use, had a higher percentage of intercourse occasions protected by condoms, and held more positive attitudes toward condoms. Women showed greater response to the intervention than men. While many behavior change effects were present at 3-, 6- and 9-month followup assessments, most diminished by the 12-month followup. These results under-score the need for tailored but ongoing HIV prevention efforts integrated into community programs that serve people with serious mental illness.