Self-monitoring Helps Reduce High-risk Behavior Among HIV-positive People
“As the number of youth infected with HIV rises, secondary prevention programs are needed to help youth living with HIV meet three goals: (a) increase self-care behaviors, medical adherence, and health-related interactions; (b) reduce transmission acts; and (c) enhance their quality of life…” The cynism of this phrase opening the abstract is insurmountable. The first, one and only goal that is helpfull to youth living with HIV is improving life quality. Reducing transmission acts is of social concern, whatever belongs to medical adherence, is at best fostering the interests of an HIV industry. The moral grounds of the latter are not as pristine as their advocats usually claim.
The results of this study are not exactly surprising after the appearance of social learning theory and cognitive behavior modification theory. According to Cameron and Best goal setting, self-monitoring and development of self- efficacy are important strategies in acquiring desired behaviors or avoiding undesired behaviors. Meichenbaum and Turk showed a modest connection between health beliefs and behavior. Correlation is strengthened with the incorporation of other determinants such as physician-patient relationship, perceived susceptibility and belief in personal self-efficacy. Self-monitoring alone are not effective, but must be employed together with negotiated, individualized, self-determined treatment goals. Offering choice of treatment alternatives, goal setting and behavioral contracting are also advocated. Albert Bandura explains comprehensively how self cognitive elements are important in regulation of human behavior. His contribution to social learning theory underlines that people act as active agents in their own self-motivation, a view that contrasts unidirectional behaviorism. Self-directive influence wherein individuals observe their own behavior, set goals and reinforce their performances are major elements in human motivation. Perceived efficacy is a more proximal determinant of behavior than outcome expectation, and motivation for behavior change should start with revealing individual efficacy expectation.
Next to smoking or breast cancer diagnosis, now the UCLA AIDS Institute study quoted below, has proven for the young living with HIV too, that self-monitoring by these patients is not only an effective strategy but is inexpensive and easy to implement as well.
By simply having patients answer a series of questions about their sexual behavior while waiting for regularly scheduled medical examinations, researchers found that people living with HIV took steps to change their behavior. The study is published in the July issue of the journal AIDS Care.
The questions brought up issues patients often had not considered, said lead author Marguerita Lightfoot, associate research psychologist at the Semel Institute for Neuroscience and Human Behavior at UCLA.
“In other studies, we often heard participants say, ‘Oh, I never really thought about my behavior like that’ when they completed study assessments,” she said. “It appeared that by completing the self-assessments, people reflected on their own behavior and changed their behavior. It’s very easy to implement and very cost effective.”
The researchers surveyed 365 people living with HIV recruited from community medical clinics and health maintenance organizations. General requirements were that they be at least 18 years old, speak English, provide written informed consent, be free of severe neuropsychological impairments and psychosis, and not be involved in any other HIV behavioral intervention study.
Participants ranged in age from 19 to 69, with a median age of 41. Ninety-two percent were male, 70 percent were gay and 13 percent were bisexual. More than half were ethnic minorities, with African Americans accounting for 21 percent, Latinos 31 percent and other non-whites 7 percent. Eighty-eight percent were high school graduates, and 62 percent had completed at least one year of college. Seventy-seven percent received services from a non-HMO clinic.
While waiting for regularly scheduled examinations, participants were taken to a private room where they answered questions about their sexual behavior on laptop computers set up for that purpose. Questions addressed the number of participants’ sexual partners, the HIV status of each partner and the number of sexual acts performed with them, and the number of times that condoms were used.
Some of the study participants completed more than four self-assessments.
Researchers found that the more self-assessments the patients completed, the higher the odds were that they would use condoms when having sex with HIV-negative partners or partners whose HIV status was unknown. Researchers also found that sexual activity tended to decrease over time as the number of self-assessments increased.
Also, as patients completed more assessments, they became increasingly aware of their risk of contracting other sexually transmitted diseases and their negative feelings about changing risky sexual behavior decreased. But neither the number of sex partners nor the fraction of protected acts with all partners showed any significant changes over time with increases in the number of self-assessments.
“Consequently, it appears that allowing PLH (people living with HIV) to reflect on their sexual behavior influences their subsequent decisions regarding sexual behavior,” the researchers wrote. “It is likely that by having the patients acknowledge and report, in a nonconfrontive and nonjudgmental manner, those behaviors that could result in transmission of HIV, their motivation to reduce HIV-transmission-related behavior increased and their attitudes became more conducive to reducing risk behaviors.”
“Consequently,” they continued, “self-assessments appear to be a promising avenue for promoting behavior change in a setting which PLH regularly interface.”
A grant from the University of California’s Universitywide AIDS Research Program to the UCLA Center for AIDS Research and Education and Lightfoot funded the study.
Behav Modif. 2007 May;31(3):345-63.
An HIV-preventive intervention for youth living with HIV.
University of California, Los Angeles, USA.
As the number of youth infected with HIV rises, secondary prevention programs are needed to help youth living with HIV meet three goals: (a) increase self-care behaviors, medical adherence, and health-related interactions; (b) reduce transmission acts; and (c) enhance their quality of life. This article describes an intervention program for youth living with HIV. Youth engage in small-group activities with other infected peers to modify their behavioral patterns. The intervention aims to (a) reduce substance use and sexual behaviors that may transmit or enhance transmission of the HIV virus; (b) reduce negative impacts of substance use on seeking and utilizing health care, assertiveness, and adherence to health regimens; and (c) enhance the quality of life to maintain behavior changes over time. Interventions that target youth living with HIV are warranted. A variety of delivery strategies are discussed for secondary interventions.
PMID: 17438347 [PubMed – indexed for MEDLINE]