A Program to Reduce Risky Sex and Substance Use among Marginally Housed Adults with HIV

This study examined the efficacy of the Healthy Living Program (a 3-module intervention — Coping, Act Safe, and Stay Healthy — each consisting of five 90-minute individual counseling sessions) in reducing risky sex and substance use among marginally housed* adults with HIV. In a larger trial, 936 adults with HIV were randomized to either the Healthy Living intervention group or to a control group that received no intervention. Participants were interviewed at baseline and at 5, 10, 15, 20, and 25 months regarding their sexual behavior and drug use. Among those who completed 4 or more assessments, 270 were marginally housed. Of these, 70% reported engaging in risky sex, 82% reported having sex with an HIV-positive or unknown serostatus partner, 80% reported alcohol or marijuana use, and 64% reported use of other drugs (including 17% who used injection drugs) at baseline.

At 25-month follow-up, marginally housed participants in the intervention group had significantly greater reductions in unprotected sex, sex with partners of HIV-negative or unknown serostatus, alcohol and/or marijuana use, and other drug use compared with those in the control group.

* Homeless at any point over a 37-month period.

Comments by James Harrison MHS. CADC
These results suggest patients utilizing HIV case management services would benefit from participation in a Healthy Living Program. Several limitations are identified by the authors; although the characteristics and risk behaviors of participants were similar to those reported nationally, this was not a representative US sample of marginally housed adults with HIV, and the majority of participants were men. Nevertheless, this study clearly demonstrates the potential of intensive, skill-focused interventions in reducing risky sex and substance use among homeless adults living with HIV.