Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients

Authors:
  • JMJoel Milam
    Joel Milam
  • AMAllen McCutchan
    Allen McCutchan
  • SSSusan Stoyanoff
    Susan Stoyanoff
  • RBRobert Bolan
    Robert Bolan
  • JWJony Weiss
    Jony Weiss
  • CKCarol Kemper
    Carol Kemper
  • RLRobert A Larsen
    Robert A Larsen
  • HHHarry Hollander
    Harry Hollander
  • PWPenny Weismuller
    Penny Weismuller
  • CCChih-Ping Chou
    Chih-Ping Chou
  • GMGary Marks
    Gary Marks
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Abstract
To test the efficacy of brief, safer-sex counseling by medical providers of HIV-positive patients during medical visits. Six HIV clinics in California. Clinics were randomized to intervention arms evaluated with cohorts of randomly selected patients measured before and after the intervention. Five-hundred and eighty-five HIV-positive persons, sexually active prior to enrollment. 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. Self-reported unprotected anal or vaginal intercourse (UAV). 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. Brief provider counseling emphasizing the negative consequences of unsafe sex can reduce HIV transmission behaviors in HIV-positive patients presenting with risky behavioral profiles.

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