Integrated HIV Care: HIV Risk Outcomes of Pregnant Substance Abusers

Abstract

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.