Date of Award

Fall 12-1-2003

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Veanne Anderson

Second Advisor

Michael Murphy

Third Advisor

June Sprock

Abstract

The Human Immunodeficiency Virus (HIV) has proliferated substantially since its initial identification in 1981. Studies ofHIV seroprevalence indicate a recent statistical surge in rural AIDS cases relative to urban locales (McKinney, 1998; Stephenson, 2000). Data also suggest adults with severe and persistent mental illness (SPMI) evidence higher behavioral risk for HIV infection than individuals in the general population (Carey, Carey, & Kalichman, 1997; McKinnon, Carey & Cournos, 1997). This study examined HIV risk behaviors in rural adults with SPMI, including analyses of sexual behaviors, psychiatric severity, and substance problems. In addition, Fisher and Fisher's (1992) Information-Motivation-Behavior (1MB) theory ofHIV risk reduction was tested, which posits lower HIV risk through accurate information regarding HIV transmission and prevention, motivation to change HIV risk behaviors and behavior skills necessary to execute HIV risk reduction strategies. Approximately 30 outpatient adults with SPMI were recruited through agencies located in a rural area of less than 50,000 persons. Participants qualified as SPMI if they had been diagnosed with a major psychiatric disorder (i.e. Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or Psychotic Disorder NOS), and had one or more resulting psychiatric hospitalization in their lifetime. Qualifying participants completed written questionnaires assessing HIV risk behavior, HIV-related knowledge, perceived risk ofHIV infection, and behavioral intentions toward HIV prevention. Alcohol problems, drug problems and lifetime number of psychiatric hospitalizations were also assessed. Results of simultaneous regression analyses indicated HIV risk behavior scores were not significantly predicted by IMB variables, suggesting Fisher and Fisher's (1992) original IMB theory to be insufficient in accounting for HIV risk in this rural sample of SPMI adults. However, higher HIV risk behaviors were significantly correlated with higher lifetime number of psychiatric hospitalizations in men, and marginally correlated with higher reported drug problems in women. The importance of sociodemographic factors such as poverty, educational level and age were also noted. Results ofthis investigation suggest ways to tailor HIV prevention efforts for SPMI adults living in rural settings.

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