Coercion or Caring: The Fundamental Paradox for Adherence Interventions for HIV+ People With Mental Illness

In AIDS and Behavior, Marlene Eisenberg and colleagues, including Nancy Hanrahan and Michael Blank, examine if a high-intensity HIV-treatment intervention would be perceived as coercive by HIV-positive individuals with serious mental illness. Previous research has shown that potentially coercive mandates during the earliest stages of mental health treatment are associated with later treatment benefits. Furthermore, the prevalence of HIV is significantly higher among populations with mental illness. The authors developed an HIV management regimen that utilized advance practice nurses (APNs), and involved activation of social networks and cell phone reminder beeps. If adherence to the treatment regimen fell below 80%, the social network and cell phone reminders would increase in intensity, and APNs would become more involved in enforcing treatment compliance. In a randomized trial of 238 dually diagnosed patients, they authors find that the group receiving the high-intensity treatment found treatment to be marginally more coercive than did the control group, who received usual treatment. However, perceived coercion was not related to the level of intensity received among the intervention group, nor to the duration of the intervention. Future researchers may use this information to design and implement more effective interventions to reduce community-based HIV incidence among vulnerable populations.