Behavioral Depression Treatment for African American HIV-infected Substance Users

Approximately 37-50% of HIV positive individuals suffer from depression, which is associated
with substance use, poor adherence to HIV medication, an increase in HIV risk behaviors, and
subsequent poor health outcomes (e.g., Asch et al., 2003; Bing et al., 2001; Dew et al.,
1997; Johnson, Rabkin, Lipsitz, Williams, & Remien, 1999). Additionally, depressed HIV
positive substance users are at an even greater risk for poor medication adherence than
non-substance users (Cook, Grey, & Burke-Miller, 2004). Notably, evidence indicates that HIV
positive patients who receive treatment for depression exhibit significant improvements in
HIV medication adherence and a reduction in risk behaviors that are directly relevant to
their health and well being such as risky sexual behavior (e.g., Cook et al., 2006). Despite
this link, few interventions targeting depression have been developed to meet the specific
needs of HIV-infected substance users. This is especially evident for low income African
American HIV positive substance users who often do not receive adequate treatment for any of
these conditions due to poverty, lack of access to specialized treatment, low motivation,
cognitive impairments, and a lack of coordination between medical, mental health, and
substance abuse treatment providers (Calsyn et al., 2004). Thus, the objective of the
present proposal is to test a novel, behavioral approach to treat depressive symptoms and
improve HIV medication adherence and subsequent physical health outcomes among 170 African
American HIV infected substance users residing in inner-city Washington, DC. This treatment
combines (1) LET'S ACT, a behavioral activation based treatment for depressed substance
users (Daughters, Braun, Sargeant, Hopko, Blanco, & Lejuez, 2008), with (2) Life Steps, an
HIV medication adherence intervention (Safren, Otto, & Worth, 1999). The purpose of this
combined treatment will be to compliment standard residential and follow-up outpatient
substance use treatment to specifically treat depressive symptoms with the additional goal
of improving HIV medication adherence, substance use, and physical health outcomes.
Participants will be randomly assigned to either treatment as usual (TAU) plus ACT HEALTHY
or TAU plus Nondirective Therapy to test the efficacy of ACT HEALTHY. Treatment as usual for
both groups consists of standard residential and outpatient substance abuse treatment. Based
on the outcome of this preliminary trial, the ACT HEALTHY protocol will be further refined
and readied for larger-scale clinical trials.

Inclusion Criteria:

- between 18 and 65 years of age

- HIV positive

Exclusion Criteria:

- psychosis

- the inability to give informed, voluntary, written consent to participate

- reading ability [below 3rd grade level on the WRAT]