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Clinic-Based Intervention Reduces Unprotected Sexual Behavior Among HIV-Infected Patients in KwaZulu-Natal, South Africa: Results of a Pilot Study

Cornman, Deborah H PhD*; Kiene, Susan M PhD; Christie, Sarah MPH*; Fisher, William A PhD; Shuper, Paul A PhD§; Pillay, Sandy MBChB; Friedland, Gerald H MD; Thomas, Cyril M BTh#; Lodge, Linda BAdmin#; Fisher, Jeffrey D PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2008 - Volume 48 - Issue 5 - p 553-560
doi: 10.1097/QAI.0b013e31817bebd7
Clinical Science

Objective: To evaluate the feasibility, fidelity, and effectiveness of a human immunodeficiency virus (HIV) prevention intervention delivered to HIV-infected patients by counselors during routine clinical care in KwaZulu-Natal, South Africa.

Methods: A total of 152 HIV-infected patients, aged 18 years and older, receiving clinical care at an urban hospital in South Africa, were randomly assigned to intervention or standard-of-care control counselors. Intervention counselors implemented a brief risk reduction intervention at each clinical encounter to help patients reduce their unprotected sexual behavior. Self-report questionnaires were administered at baseline and 6 months to assess number of unprotected sex events in previous 3 months.

Results: Intervention was delivered in 99% of routine patient visits and included a modal 8 of 8 intervention steps. Although HIV-infected patients in both conditions reported more vaginal and anal sex events at 6-month follow-up than at baseline, patients who received the counselor-delivered intervention reported a significant decrease over time in number of unprotected sexual events. There was a marginally significant increase in these events among patients in the standard-of-care control condition.

Conclusions: A counselor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African clinical care setting and effective at reducing unprotected sexual behavior.

From the *Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT; †Substance Abuse Research Unit, Division of General Internal Medicine, Alpert Medical School of Brown University, Providence, RI; ‡Departments of Psychology and Obstetrics and Gynaecology, University of Western Ontario, London, Ontario, Canada; §Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychology, University of Toronto, Ontario, Canada; ‖AIDS Clinical Trials Group, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; ¶AIDS Program, Infectious Diseases Section, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT; and #Sinikithemba Care Centre, McCord Hospital, Durban, South Africa.

Received for publication November 10, 2007; accepted March 11, 2008.

Cornman DH, Kiene SM, Christie S, Fisher WA, Shuper PA, Pillay S, Friedland GH, Thomas CM, Lodge L, Fisher JD. Izindlela Zokuphila/Options for Health: Counselor-delivered risk reduction intervention reduces unprotected sex among patients in clinical care in KwaZulu-Natal, South Africa. Paper presented at: AIDS Impact 2007: 8th International Conference on Biopsychosocial Aspects of HIV Infection; July 3, 2007; Marseilles, France.

Supported by the National Institutes of Mental Health (grant no. RO1 MH59473-05) and by a development grant from the Center for Health, Intervention, and Prevention at the University of Connecticut.

Correspondence to: Deborah H. Cornman, PhD, Center for Health, Intervention, and Prevention, 2006 Hillside Road, Unit 1248, University of Connecticut, Storrs, CT 06269 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.