Modeling a Theory-Based Approach to Examine the Influence of Neurocognitive Impairment on HIV Risk Reduction Behaviors Among Drug Users in Treatment

Abstract

Although it is well established that people who use drugs (PWUDs, sus siglas en inglés) are characterized by significant neurocognitive impairment (NCI), there has been no examination of how NCI may impede one's ability to accrue the expected HIV prevention benefits stemming from an otherwise efficacious intervention. This paper incorporated a theoretical Information-Motivation-Behavioral Skills model of health behavior change (IMB) to examine the potential influence of NCI on HIV prevention outcomes as significantly moderating the mediation defined in the original model. The analysis included 304 HIV-negative opioid-dependent individuals enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed interaction effects between NCI and HIV risk reduction information such that the predicted influence of HIV risk reduction behavioral skills on HIV prevention behaviors was significantly weakened as a function of NCI severity. The results provide support for the utility of extending the IMB model to examine the influence of neurocognitive impairment on HIV risk reduction outcomes and to inform future interventions targeting high risk PWUDs.

Keywords: Drug users; HIV risk reduction; IMB model; Moderated mediation; Neurocognitive impairment.

Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflict of interest.

Figures

Figure 1

The information–motivation-behavioral skills model (IMB) of HIV preventive behavior (Fisher & Fisher, 1994)

Figure 2

The IMB model-based measure of neurocognitive impairment (nciIMB model) for clean needle use among high risk drug users

Figure 3

The IMB model-based measure of neurocognitive impairment (nciIMB model) for male condom application among high risk drug users

Figure 4

The IMB model-based measure of neurocognitive impairment (nciIMB model) for female condom application among high risk drug users