Avants S Kelly, Margolin Arthur, Usubiaga Mary Helen, Doebrick Cheryl
Yale University School of Medicine, Department of Psychiatry, Welch Building, 495 Congress Avenue, New Haven, CT 06519, USA.
J Subst Abuse Treat. 2004 Mar;26(2):67-78. doi: 10.1016/S0740-5472(03)00159-4.
Methadone maintenance programs (MMP) have the potential to play an important role in reducing HIV risk, given the appropriate type and level of ancillary treatments. In this study, we investigated the efficacy of a 12-session harm reduction group intervention for injection drug users, based upon the Information-Motivation-Behavioral skills model of behavior change, that focused on reducing both drug and sex risk. Two hundred and twenty patients entering an MMP were randomized to receive either standard care (SC)-2 hours of counseling per month and a single-session risk reduction intervention-or SC plus the harm reduction group (HRG). Results showed that during treatment, patients receiving HRG were more likely to be abstinent from cocaine and to report fewer unsafe sexual practices. Post-treatment, HRG patients scored higher on a sexual risk quiz and reported increased self-efficacy in high risk sexual situations. Enhancing methadone maintenance with a weekly harm reduction group treatment was somewhat more expensive but can bring about positive changes in behaviors and attitudes that are associated with the transmission of HIV.
鉴于辅助治疗的适当类型和水平，美沙酮维持治疗项目（MMP）在降低艾滋病毒风险方面具有发挥重要作用的潜力。在本研究中，我们基于行为改变的信息-动机-行为技能模型，对注射吸毒者进行了为期12节的减少伤害小组干预，该干预侧重于降低毒品和性风险。220名进入MMP的患者被随机分配接受标准护理（SC）——每月2小时咨询和单次减少风险干预——或SC加减少伤害小组（HRG）。结果显示，在治疗期间，接受HRG的患者更有可能戒除可卡因，报告的不安全性行为也更少。治疗后，HRG患者在性风险测验中的得分更高，并报告在高风险性行为情境中的自我效能感有所提高。通过每周一次的减少伤害小组治疗来加强美沙酮维持治疗成本略高，但可以在与艾滋病毒传播相关的行为和态度方面带来积极变化。
