Background and Objective: HIV prevention counseling has changed behavior and reduced incident sexually transmitted diseases (STDs) in research participants.
Goal: This article assesses whether counselor demographics or counselor–client dyad characteristics influenced prevention counseling in Project RESPECT as measured by intervention completion and incident STD after counseling.
Study Design: We analyzed data from Project RESPECT, a randomized, controlled trial of HIV counseling interventions in STD clinics.
Results: There was no significant association between client failure to complete the intervention and demographic characteristics of the 32 counselors or dyad characteristics. Clients who did not complete the intervention were significantly more likely to acquire a new STD infection by the 12-month visit than those who completed the intervention (adjusted odds ratio, 1.7; confidence interval, 1.2–2.4). There was no significant association between new STDs and counselor characteristics or dyad characteristics.
Conclusions: Counselor or counselor–client dyad characteristics evaluated in this study were not associated with intervention completion or the prevention of new STDs.
RESEARCH ON PREVENTION counseling has focused primarily on demonstrating that counseling is effective in reducing risk behaviors. Little research has focused on specific demographics or characteristics of the counselor, or the counselor–client dyad, which could influence the effectiveness of counseling. As evidence is collected documenting the effectiveness of prevention counseling as an intervention to prevent HIV and sexually transmitted diseases (STDs), 1–3 it is important to identify characteristics of effective counseling sessions and the circumstances under which counseling sessions are likely to reduce risk behavior.
HIV/STD prevention counseling is a brief behavior change intervention focused on risk. Counselors help clients understand their risk pattern, and triggers and then motivates them to reduce risk. The client and counselor explore risk-reduction options to identify a single step to which the client will commit to reduce their risk. One model of prevention counseling that has been proven effective is client-centered counseling. 1,4 Client-centered HIV prevention counseling is an interactive, one-on-one intervention in which the counselor encourages the client to play an active role in developing a personalized HIV risk-reduction plan. Preferably, clients develop their own risk-reduction goals by developing a series of concrete, achievable, risk-reduction steps. The model was developed by counseling experts and has been recommended by the Centers for Disease Control and Prevention (CDC) since 1993 for use with HIV counseling and testing in public clinic settings. 5 Client-centered HIV prevention counseling is adapted to client’s culture, sensitive to issues of sexual identity, developmentally appropriate, and delivered in the client’s primary language. 4
An integral part of prevention counseling involves counselor training and ongoing supervision and feedback to maintain the quality and effectiveness of the counseling. Although the 2001 CDC revised guidelines for HIV prevention counseling highlight the skills and attitude counselors need, they do not identify specific demographics or characteristics counselors or counselor–client dyads must possess to be effective. 4
The psychologic literature identifies counselor characteristics that influence intervention effectiveness to empathic understanding, positive regard, genuineness, appropriate self-disclosure, spontaneity, confidence, intensity, openness, flexibility, commitment, and credibility. 6,7 The theory of social influence postulates that counselor credibility, attractiveness, and influence depend on similarity between the counselor and client. 7–9 Therefore, it is believed that counselors of the same ethnicity or gender as their clients are better able to understand and serve their clients. On the other hand, counselors who subscribe to the crosscultural or cross-gender counseling theories believe sensitive counselors transcend differences between themselves and their clients, including cultural and gender differences. 7,8,10
Many HIV prevention researchers believe outcomes improve if intervention counselors are matched with clients according to gender, ethnicity, and sexual orientation. However, this effect has not been demonstrated. 11 Intervention completion is one outcome that could measure the counselor’s ability to connect with the client. Although a number of elements likely contribute to intervention completion, a client’s initial interaction with and perception of the counselor could be an important one. For a client to be motivated to complete the intervention, interactions with the counselor should be perceived as positive. However, because the goal of prevention counseling is the prevention of new STDs, including HIV, the main measure of effective counseling should be the ability to prevent STDs. Although there are many characteristics that likely influence counseling, we were limited to those collected as part of Project RESPECT. We assessed whether demographics or specific characteristics of counselor or counselor–client dyads influenced the effectiveness of prevention counseling in Project RESPECT as measured by intervention completion and incident STD after counseling.