The Moderating Effects of Psychiatric Symptoms on Changes in Condom Self-Efficacy Following an HIV Prevention Intervention with Brazilian Men and Women in Psychiatric Outpatient Care
Open AccessThe purpose of this study is to examine the moderating effects of psychiatric symptoms on changes in condom self-efficacy among a psychiatric outpatient population following an HIV prevention intervention. People living with severe mental illness (SMI) experience disproportionately higher rates of HIV infection compared to the general population, and psychiatric symptoms of bipolar disorder (e.g., mania), schizophrenia (e.g., emotional withdrawal), and mood disorders (e.g., depression, anxiety) have been shown to be associated with increased sexual risk behavior. While the impact of psychiatric symptoms on sexual risk behaviors has been documented, little is known about the possible moderating impact psychiatric symptoms may have on psychosocial factors (i.e., condom self-efficacy) that influence sexual risk behaviors. An outpatient psychiatric population (N = 464) was recruited from eight psychiatric clinics in Rio de Janeiro, Brazil and randomized into either an HIV prevention intervention or a health control condition. Participant data including psychiatric symptom presentation and condom self-efficacy were collected via a structured interview at baseline, post-intervention, 3-, 6-, and 12-month follow up. Structural equation modeling was used to identify changes in condom self-efficacy and psychiatric symptom clusters (i.e., affective, positive, negative, and activation) longitudinally. The findings of the current study demonstrated that an HIV prevention intervention can increase condom self-efficacy post-intervention lasting up to 1 year compared to control condition, and findings were consistent across gender and racial groups. The findings of the current study did not show psychiatric symptoms to have a moderating impact on changes in condom self-efficacy following an intervention. Post hoc-analyses, however, did yield significant relationships between psychiatric symptoms and condom self-efficacy. Activation symptoms (e.g., elated mood, excitement) may be predictive of condom self-efficacy, and affective symptoms and condom self-efficacy may influence each other concurrently. Unanticipated temporal relationships were also identified where condom self-efficacy may be predictive of positive (e.g., grandiosity, paranoia) and negative (e.g., emotional withdrawal) symptoms, which may be attributable to: confounders influencing condom self-efficacy and psychiatric symptoms; the differential impact of specific symptoms within a cluster on condom self-efficacy (e.g. grandiosity vs. suspiciousness); and/or participation in a group intervention having universal benefit for people experiencing emotional withdrawal. The findings of this study underscore the utility and effectiveness of HIV prevention interventions in increasing skills and confidence in negotiating safer sex practices among vulnerable populations such as people living with SMI. This study also sheds light on understudied aspects of sexual risk, namely the interplay of psychiatric symptoms and condom self-efficacy, which may have implications for tailoring interventions to meet the needs of diverse psychiatric symptom presentations in psychiatric populations.
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