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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

Healthy Living Project (HLP)

BEST-EVIDENCE

Intervention Description

Target Population
HIV-positive persons at risk of transmitting HIV

Goal of Intervention

  • Eliminate or reduce sexual transmission risk behavior
  • Eliminate or reduce injection drug use risk behaviors
  • Improve health care practices and quality of life

Brief Description

Healthy Living is a 3-module/15-session intervention that is delivered one-on-one to people living with HIV. Each of the 3 modules consists of 5 sessions, and each is designed to improve quality of life in a different broad area of health: physical, mental, and sexual. More specifically, the modules focus on developing positive strategies for managing symptoms of depression, anxiety, complex medication regimens, injection drug use, and sexual risk behavior in order to avoid unwanted consequences for themselves, their friends, families, and partners. Module 1 (stress, coping, and adjustment), focuses on quality of life, psychologic coping, and achieving positive affect and supportive social relationships. Module 2 (safer behaviors), centers on self-regulatory issues, such as avoiding risky sexual and drug use behavior. Module 3 (health behaviors), addresses accessing health services, adherence, and active participation in medical care decision making. Sessions have a standard structure and set of activities that are tailored to the individual participant. Psychoeducation, skills-building exercises, and cognitive-behavioral techniques (trigger identification, problem solving, and goal setting) are included in each session so the participant can use these skills independently to effectively meet challenges in their daily lives.

Theoretic Basis
Social Action Theory

Intervention Duration
Fifteen 90-minute sessions were grouped into 3 modules. Each module was delivered over 2 months, with 3 months between modules for a total duration of 12 months.

Intervention Setting
Private settings in community-based organizations and clinics

Deliverer
Ethnically diverse, gender-matched female and male facilitators with experience as social workers, counselors, therapists, or community-based service providers

Delivery Methods

  • Coping strategies
  • Demonstration
  • Goal Setting
  • Problem-solving
  • Role plays

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Intervention Package Information

Intervention materials are available Center for AIDS Prevention Studies (CAPS).

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Evaluation Study and Results

The original evaluation study was conducted in Los Angeles and San Francisco, California; Milwaukee, Wisconsin; and New York City, New York between 2000 and 2004.

Key Intervention Effects

  • Reduced unprotected sex acts with persons of HIV-negative or unknown serostatus

Study Sample
The baseline study sample of 936 HIV-positive men and women is characterized by the following:

  • 45% African American, 32% White, 15% Hispanic, 8% Other
  • 79% Male, 21% Female
  • 57% MSM (72% of men are MSM)
  • Mean age of 40 years, range: 19-67 years
  • 81% completed high school education or more

Recruitment Settings
Community agencies and medical clinics

Eligibility Criteria
Men and women were eligible if they had medical documentation of their HIV infection, and were at least 18 years of age, free of severe neuropsychologic impairment or psychosis, not currently involved in another HIV-related behavioral intervention study, and self-reported unprotected intercourse with an HIV-negative or unknown serostatus partner in the past 3 months, or with an HIV-infected non-primary partner.

Assignment Method
HIV-positive persons (N = 936) were randomly assigned to 1 of 2 groups: Healthy Living intervention (n = 467) or wait-list control (n = 469).

Comparison Group
The wait-list control group received a delayed intervention following completion of the study.

Relevant Outcomes Measured and Follow-up Time
HIV transmission risk acts during past 3 months (defined as unprotected insertive or receptive anal or vaginal intercourse with partners of negative or unknown HIV serostatus) were measured at 5, 10, 15, 20, 25 months post baseline, which translates to assessments during the intervention and approximately 3, 8, and 13 months post module 3.

Participant Retention

  • Healthy Living Intervention:
    84% retained at 5 months post baseline
    81% retained at 10 months post baseline
    78% retained at 15 months post baseline
    73% retained at 20 months post baseline
    73% retained at 25 months post baseline
  • Wait-List Control:

    88% retained at 5 months post baseline
    84% retained at 10 months post baseline
    83% retained at 15 months post baseline
    79% retained at 20 months post baseline
    81% retained at 25 months post baseline

Significant Findings

  • Healthy Living participants reported significantly fewer HIV transmission risk acts than the wait-list control participants at 8 months after the completion of all three modules (p = .007).
  • Across the four assessments (5 to 25 months post baseline), Healthy Living participants reported significantly fewer HIV transmission risk acts than the wait-list control participants (p = .007).

Considerationss

  • Despite randomized allocation to study arms, there were baseline differences between the intervention and control arms. These differences were statistically adjusted using propensity scores.

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References and Contact Information

  • Healthy Living Project Team. (2007). Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: The Healthy Living Project randomized controlled study. Journal of Acquired Immune Deficiency Syndromes, 44, 213-221.

Researcher: Steven F. Morin, PhD
Center for AIDS Prevention Studies
University of California, San Francisco
50 Beale Street, Suite 1300
San Francisco, CA, 94105
email: steve.morin@ucsf.edu

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