The impact of emotional distress on HIV risk reduction among women.

This study evaluated whether 333 seronegative African American female drug users (aged 18-59 years) participating in an HIV intervention and with higher levels of emotional distress, specifically symptoms of depression and anxiety, reduced HIV risk behaviors to a lesser extent than those with lower levels of emotional distress. Participants were recruited between June 1998 and January 2001 from inner-city Atlanta (Georgia, U.S.) neighborhoods and were randomly assigned to one of two enhanced gender-specific and culturally specific HIV intervention conditions or to the NIDA standard condition. Participants were interviewed at baseline, post-intervention and at 6-month follow-up with a structured questionnaire including information on sociodemographics, sexual and drug-using behavior, and psychosocial characteristics. Despite a significant decline in symptoms of emotional distress during the study period, the women in this sample reported high levels of depressive and anxiety symptoms at baseline and 6-month follow-up. Higher levels of emotional distress were positively associated with post-intervention sexual and drug-taking risk. Women in both enhanced intervention conditions reduced their sexual and drug-taking risks more than women in the standard intervention. Those in the motivation intervention arm experienced a greater reduction in depressive symptoms, accompanied by a greater reduction in sexual risk behavior. Findings suggest the need for effective interventions and mental health resources among subgroups of high-risk women who may be most resistant to behavioral change.