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Compendium of Evidence-Based HIV Behavioral Interventions

Healthy Relationships

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Intervention Description

Target Population
People living with HIV

Goal of Intervention
Reduce HIV-transmission risk behaviors

Brief Description

Healthy Relationships is a small-group, skills-based behavioral intervention for men and women living with HIV. The intervention focuses on skills building, self-efficacy, and positive expectations about new behaviors. Through group discussions, role plays, videos and skill-building exercises, the intervention helps persons living with HIV develop skills to cope with HIV-related stressors and risky sexual situations. Intervention sessions also enhance decision-making skills for self-disclosing HIV-serostatus to sex partners, and help participants develop and maintain safer sex practices. Participants receive personalized feedback about their own risk practices, and with the help of the intervention group, develop strategies to maintain satisfying relationships while protecting both themselves and their partners. Intervention sessions are conducted separately for men and women in groups of 6–10 participants.

Theoretic Basis
Social Cognitive Theory

Intervention Duration
Five 2-hour sessions, with 2 sessions delivered weekly for 2.5 weeks

Intervention Setting
Community AIDS service organization

Deliverer
One male and one female group facilitator, one of whom is an HIV-positive peer counselor

Delivery Methods

  • Exercises
  • Goal setting
  • Group discussions
  • Lectures
  • Printed materials
  • Role plays
  • Video

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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.Link to non CDC website

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Evaluation Study and Results

The original evaluation study was conducted in Atlanta, Georgia between 1997 and 1998. The study included a sample of 328 men and women living with HIV, 48% of whom had a high-school degree or less.

Key Intervention Effects

  • Reduced unprotected anal or vaginal intercourse
  • Fewer non-HIV+ sex partners
  • Increased condom use
  • Increased refusal of unsafe sex

Study Sample

  • 74% African American; 22% White; 4% other
  • 70% Male; 29% Female; 1% Transgender
  • 52% homosexual; 39% heterosexual; 9% bisexual
  • Mean age of 40 years

Recruitment Settings
AIDS services and infectious disease clinics

Eligibility Criteria
Men and women were considered eligible for the evaluation if they were living with HIV/AIDS and willing to complete the study activities.

Assignment Method
Participants were randomly assigned to either the Healthy Relationships intervention (n = 185) or to a health maintenance comparison intervention (n = 143).

Comparison Group
The health maintenance comparison intervention consisted of five 2-hour group sessions that included social support groups for people living with HIV. The sessions also provided informational updates on HIV disease, management of health problems, medication adherence, health care and health insurance concerns, and nutrition. Participants also developed personalized health maintenance plans.

Relevant Outcomes Measured and Follow-up Time

  • Sexual risk behaviors during the prior 3 months (including number of sex partners; number of unprotected vaginal and anal sex acts; proportion of protected vaginal and anal sex acts; and having safer sex without disclosure of HIV status) were assessed at 3- and 6-month follow-ups.
  • Refusal of unsafe sex during the prior 3 months was assessed at 3- and 6-month follow-ups.

Participant Retention

  • Intervention:
    81% retained at 3 months
    79% retained at 6 months
  • Comparison:
    85% retained at 3 months
    77% retained at 6 months

Significant Findings

  • At both the 3- and 6-month follow-ups, participants in the Healthy Relationships intervention reported significantly fewer occasions of unprotected vaginal/anal sex with non-HIV+ partners than those in the comparison intervention.
  • At the 6-month follow-up, intervention participants significantly reduced their total number of occasions of vaginal/anal sex and occasions of unprotected vaginal/anal sex, and reported fewer non-HIV+ partners than participants in the comparison group.
  • Finally, intervention participants reported a significantly greater proportion of condom use for vaginal/anal sex and refusal of unsafe sexual practices at the 6-month follow-up than comparison group participants.

Considerations

  • The comparison group participants were unexpectedly, but significantly, more likely to have refused unsafe sexual practice at the 3-month follow-up. This finding was reversed at the 6-month follow-up.

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References and Contact Information

  • Kalichman, S.C., Rompa, D., Cage, M., et al. (2001). Effectiveness of an intervention to reduce HIV transmission risk in HIV-positive people. American Journal of Preventive Medicine, 21(2), 84–92.
  • Kalichman, S.C., Rompa, D., Cage, M. (2005). Group intervention to reduce HIV transmission risk behavior among persons living with HIV-AIDS. Behavior Modification, 29(2), 256–285.

Researcher: Dr. Seth Kalichman
Department of Psychology, University of Connecticut
406 Babbidge Rd
Storrs, CT 06269
email: seth.k@uconn.edu

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