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AIDS:
Epidemiology & Social

Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment

Richardson, Jean L; Milam, Joel; McCutchan, Allena; Stoyanoff, Susan; Bolan, Robertb; Weiss, Jony; Kemper, Carolc; Larsen, Robert Ad; Hollander, Harrye; Weismuller, Pennyf; Chou, Chih-Ping; Marks, Garyg

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Abstract

Objective: To test the efficacy of brief, safer-sex counseling by medical providers of HIV-positive patients during medical visits.

Setting: Six HIV clinics in California.

Design: Clinics were randomized to intervention arms evaluated with cohorts of randomly selected patients measured before and after the intervention.

Participants: Five-hundred and eighty-five HIV-positive persons, sexually active prior to enrollment.

Interventions: Prevention counseling from medical providers supplemented with written information. Two clinics used a gain-framed approach (positive consequences of safer-sex), two used a loss-frame approach (negative consequences of unsafe sex), and two were attention-control clinics (medication adherence). Interventions were given to all patients who attended the clinics.

Outcome measure: Self-reported unprotected anal or vaginal intercourse (UAV).

Results: Among participants who had two or more sex partners at baseline, UAV was reduced 38% (P < 0.001) among those who received the loss-frame intervention. UAV at follow-up was significantly lower in the loss-frame arm [odds ratio (OR), 0.42; 95% confidence interval (CI), 0.19–0.91; P = 0.03] compared with the control arm. Using generalized estimating equations (GEE) to adjust for clustering did not change the conclusions (OR, 0.34; 95% CI, 0.24–0.49; P = 0.0001). Similar results were obtained in participants with casual partners at baseline. No effects were seen in participants with only one partner or only a main partner at baseline. No significant changes were seen in the gain-frame arm.

Conclusions: Brief provider counseling emphasizing the negative consequences of unsafe sex can reduce HIV transmission behaviors in HIV-positive patients presenting with risky behavioral profiles.

© 2004 Lippincott Williams & Wilkins, Inc.

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