Brazilian HIV Prevention Intervention

About The Program

People with mental illness are particularly vulnerable to infection with HIV – a reality reflected in the exceptionally high rates of infection within this population. A number of factors contribute to elevated HIV risk among the mentally ill, including substance abuse, unstable housing, poverty, stigma, engagement in unprotected sex, or unsafe drug injection practices. As a result, people with mental illness have been a focus of HIV research for over 20 years, with particular emphasis placed on the development and evaluation of interventions to reduce HIV-related risk behaviors. In Brazil, which has the highest prevalence of HIV-positive adults in all of South and Central America, the need for effective, culturally-adapted HIV prevention interventions is particularly dire.

Background

Under the leadership of Principal Investigator Dr. Milton Wainberg, this NIMH-funded grant piloted a culturally appropriate HIV prevention intervention in Brazil men and women with severe mental illness, through the adoption and refinement of evidence-based efficacious prevention interventions developed for use with patients in the U.S. with severe mentally illness.

Study Aims

Employing a participatory research model that engages both local providers as well as patients, this initiative aimed to facilitate the transfer and implementation of feasible intervention knowledge that balances fidelity of efficacious research with fit to the new setting’s culture and context.

Following the success of this pilot study, further NIMH funding was secured to test the efficacy of this HIV prevention intervention in all the Rio de Janeiro Municipal clinics providing care for individuals with severe mental illness. Using sites that are representative of outpatient treatment delivery settings across Brazil, the study conducted an RCT to test the long-term efficacy of its Brazilian HIV Prevention Intervention for men and women with severe mental illness.

The Brazilian team has now developed a training program that visits psychiatric sites all over the country with funding from the Brazilian Ministry of Health to train providers.

Related Publications

Wainberg ML, McKinnon K, Mattos PE, Pinto D, Gruber Mann C, Oliveira C, Oliveira-Broxado S, Remien RH, Elkington KS, Cournos F, PRISSMA Project. A model for adapting evidence-based behavioral interventions to a new culture: HIV prevention for psychiatric patients in Rio de Janeiro, Brazil. AIDS and Behavior 2007; 11(6): 872-83.

Wainberg ML, Alfredo Gonzalez M, McKinnon K, Elkington KS, Pinto D, Gruber Mann C, Mattos PE. Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness. Social Science & Medicine 2007; 65(2): 296-308.

Wainberg ML, McKinnon K, Elkington K, Mattos PE, Gruber Mann C, Souza Pinto D, Otto-Salaj L, Cournos F. HIV risk behaviors among outpatients with severe mental illness in Rio de Janeiro, Brazil. World Psychiatry 2008; 7(3): 166-72.

Elkington KS, McKinnon K, Mann CG, Collins PY, Leu CS, Wainberg ML. Perceived mental illness stigma and HIV risk behaviors among adult psychiatric outpatients in Rio de Janeiro, Brazil. Community Mental Health Journal 2010; 46(1): 56-64.