Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information

Intervention Description

Target Population
HIV-positive clinic patients

Goals of Intervention
Eliminate or reduce unprotected anal or vaginal sex

Theoretic Basis

• Message Framing Theory
• Mutual Participation
• Stages of Changes

Intervention Duration
A 3- to 5-minute session at every clinic visit over 10 to 11 months

Intervention Settings
HIV clinics

Deliverer
Medical providers at the clinics (e.g., physician, physician assistant, nurse, nurse practitioner)

Delivery Methods

• Counseling
• Goal setting
• Printed Materials

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Intervention Package Information

An intervention package was developed with funding from CDC’s Replicating Effective Programs (REP) Project. Dissemination of the PfH program is now coordinated through the Capacity Building Assistance Center at University of Texas Southwestern Allied Health Sciences School, 400 S. Zang, Suite 520, Dallas TX. 75208 : Attention: Daniel Casillas [Daniel.Casillas@UTSouthwestern.edu] (214) 645-7313. An intervention manual and other materials are also available on the principal author’s website.

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Evaluation Study and Results

The original evaluation was conducted in 6 large HIV clinics in California between 1998 and 2000.

Key Intervention Effectss

• Reduced unprotected sex

Study Sample
The analytic study sample of 585 HIV-positive clinic patients is characterized by the following:

• 41% White, 37% Hispanic, 16% African American, 6% Other
• 86% Male, 14% Female
• 75% homosexual/bisexual, 25% heterosexual
• Mean age of 38 years
• 46% completed high school education or less

Recruitment Settings
Six HIV Clinics

Eligibility Criteria
HIV-positive patients were eligible if they were sexually active in the previous 3 months, at least 18 years old, fluent in English or Spanish, and intended to obtain care at the recruitment clinic for the next year.

Assignment Method
Six HIV clinics were randomly assigned to 1 of 3 groups: Loss-frame intervention (n = 2 clinics; 214 patients assessed), Gain-frame intervention (n = 2 clinics; 175 patients assessed), or Medication Adherence comparison (n = 2 clinics; 196 patients assessed). In each clinic, all patients were offered the intervention and sub-samples of clinic patients were systematically selected for assessment.

Comparison Group
The Medication Adherence comparison group received a one-on-one, brief provider-administered counseling session (3-5 minutes) to promote medication adherence at each clinic visit.

Relevant Outcomes Measured and Follow-up Time
Sex behaviors during past 3 months (including anal, vaginal and oral sex with or without using a condom with main partners, casual partners, or exchange partners) were measured at 1 to 7 months after intervention.

Participant Retention

• Loss-frame intervention:

  72% retained at 1 to 7 months after intervention

• Gain-frame intervention:

  58% retained at 1 to 7 months after intervention

• Medication Adherence comparison:

  68% retained at 1 to 7 months after intervention

Significant Findings

• Among HIV-positive patients who had 2 or more sex partners at baseline, those assigned to the Loss-frame intervention were significantly less likely to report unprotected anal/vaginal intercourse than those in the comparison group at 1 to 7 months after intervention (p = .03). This intervention effect was also found to be significant among men who have sex with men with 2 or more sex partners at baseline (p = .04).
• Among HIV-positive patients who had any casual/exchange partners at baseline, the Loss-frame intervention participants were significantly less likely to report unprotected anal/vaginal intercourse than the comparison participants at 1 to 7 months after intervention (p = .04).

Considerations

• The Partnership for Health Loss-frame intervention fails to meet the best-evidence criteria due to a short follow-up time and low retention rates.
• Although, the Loss-frame intervention reduced unprotected anal/vaginal sex among HIV-positive patients with 2 or more sex partners, patients with one sexual partner at baseline were unaffected by the intervention.
• The Gain-frame intervention, which has the same format as the loss-frame intervention but emphasizes the benefits or positive consequences of protective behavior, fails to meet the promising-evidence criteria due to no statistically significant intervention effects on sex risk behaviors at the follow-up and low retention rates.
• This intervention could be considered a structural-level intervention as the entire clinic procedures were altered and all clinic patients received the intervention while only a sample of patients were included in the evaluation. Since the evaluation used a cohort design, which can be reviewed with these criteria, this intervention is included within this review & also will be updated later in the community-level and structural-level intervention section of the website.

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References and Contact Information

• Richardson, J. L., Milam, J., McCutchan, A., Stoyanoff, S., Bolan, R., Weiss, J., et al. (2004). Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: A multi-clinic assessment. AIDS, 18, 1179-1186.

  Researcher: Dr. Jean L. Richardson, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 3409, Los Angeles, CA 90089-9175. email: jeanr@usc.edu

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