An empirical test of the information, motivation and behavioral skills model of antiretroviral therapy adherence.

Nearly perfect adherence to demanding antiretroviral therapy (ART) is now recognized as essential for HIV-positive patients to realize its life sustaining benefits. Despite the dire consequences of non-adherence, a large number of patients do not follow their ART regimen. While many factors influence adherence, the literature is dominated by studies on only one or a small set of them. Multivariate, theory-based models of adherence behavior are of great interest. The current study tested one such model, the Information, Motivation and Behavioral Skills (IMB) model of ART adherence (Fisher et al., under review). A sample of HIV-positive patients on ART in clinical care in Puerto Rico (N=200) provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Structural equation model tests used to assess the propositions of the IMB model of ART adherence provided support for the interrelations between the elements proposed by the model and extended previous work. Implications for future research and intervention development are discussed.

[Health promotion work in a community of sex workers in San Juan, Puerto Rico and human immunodeficiency virus (HIV / AIDS) prevention]. / Trabajo en promocion de salud en una comunidad de trabajadores sexuales en San Juan (Puerto Rico) y la prevencion del virus de inmunodeficiencia humana (VIH / SIDA).

PIP: An intervention model for prevention of HIV infection among male transvestite sex workers in San Juan, Puerto Rico, is described. Sex workers have been neglected in most AIDS prevention programs, primarily due to the moralistic attitudes permeating most prevention models. The model was viewed as existing in the context of the sex industry, in order to deflect attention from the prostitute and direct it to the whole series of relations between the client, sex worker, policeman, and others involved. Health promotion strategies must recognize that the sex industry will always exist. Promotion of healthier lifestyles, of community consciousness, and of more responsible sexuality must take place according to the reality of the culture and reference points of the target community. The AIDS Foundation of Puerto Rico in 1991 extended its work among homosexuals to include male transvestites in San Juan. A male transvestite was contracted to work full time for the project. In the beginning, his activities were limited to being present in the street, identifying himself and speaking informally about AIDS and the project, and distributing condoms. Nine months later, the sex workers requested HIV testing, which revealed that 95% of the 48 tested were seronegative. 19 transvestites were interviewed in August 1992 to provide information on the characteristics and needs of the community. The workers were found to be young, with relatively limited education, incomes primarily from sex work, and high levels of alcohol and drug use. Most had no regular partners and the majority of their sexual activity was with clients. Over half engaged in high risk sexual activity without protection. The intervention model, developed with information collected from the transvestites and using as a frame of reference some models for similar populations, called for 8 weekly 1-hour sessions intended to provide information on HIV/AIDS, strengthen participant self-esteem, reduce high risk behaviors, increase safe sex practices, and initiate a process of community promotion. Each session had specific objectives to be met using a variety of participatory activities directed by members of the same or related communities. The themes were selected by the participants. A follow-up questionnaire 3 months later attempted to evaluate the impact of the intervention on sexual behavior, general health habits, and alcohol use.^ieng