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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
Brief Description
The Partnership for Health (PfH)
Loss-frame intervention is a one-on-one,
brief provider-administered safer sex
intervention for HIV-positive persons in
care. The intervention emphasizes the
importance of the patient-provider
relationship to promote patients’
healthful behavior. At each clinic
visit, the provider delivers a brief
counseling session (3-5 minutes) with
messages that focus on self-protection,
partner protection, and disclosure.
Loss-framed messages are framed in a way
that emphasizes the risks or negative
consequences of risky behavior. The
provider also uses the brochures,
informational flyers and posters with
the loss-framed messages to facilitate
counseling and work with the patient to
identify goals for the patient to work
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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. The intervention package and training are available through CDC’s
Diffusion of Effective Behavioral Interventions (DEBI) project.
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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
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, NTT 3409A
Los Angeles, CA 90089-9175
email: jeanr@usc.edu
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