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.
From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, the aUniversity of California at San Diego, San Diego, the bDepartment of Family Medicine, Keck School of Medicine, University of Southern California, and Los Angeles Gay and Lesbian Center, Los Angeles, the cHIV Positive PACE Clinic, Santa Clara Valley Medical Center, San Jose, the dDepartment of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, the eUniversity of California at San Francisco, San Francisco, the fOrange County Health Care Agency, Santa Ana, California and the gCenters for Disease Control and Prevention, Atlanta, Georgia, USA.
Correspondence to J. Richardson, Department of Preventive Medicine, Keck School of Medicine – USC, 1441 Eastlake Ave, MS 9175, Los Angeles, CA 90033, USA.
Received: 25 September 2003; revised: 5 January 2004; accepted: 9 March 2004.