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Compendium of Evidence-Based HIV Behavioral Interventions

HIV Education and Testing

GOOD-EVIDENCE

Intervention Description

Target Population
Inner-city sexually active heterosexual STD clinic patients

Goals of Intervention

  • Eliminate or reduce sex risk behaviors

Brief Description

The intervention consists of an educational component and an HIV blood test for STD patients. The educational component includes a (a) written pamphlet that explicitly discusses safe and unsafe sexual acts and explains condom use; (b) 15-minute video that examines HIV risk behavior, promotes condom use, and discusses potential risks with sex partners; and (c) 10-minute, one-on-one counseling session with a physician. The counseling session, which includes all usual aspects of HIV pretest counseling, focuses on assessing personal risk, discussing the elements of HIV testing, and answering any questions about HIV/AIDS or testing. After completing the educational module, intervention participants have blood drawn for an HIV test. Test results are revealed approximately 2 weeks after study entry and are accompanied by the same risk reduction messages as those presented during the pre-test counseling (for seronegative results) or in-depth counseling (for seropositive results).

Theoretic Basis
None specified

Intervention Duration
Two sessions approximately two weeks apart (one prior to and one after HIV testing)

Intervention Settings
Inner-city STD clinic

Deliverer
A physician (educational module) and clinic nurse (for the clinic blood draw)

Delivery Methods

  • Counseling
  • Pamphlets
  • Video

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Intervention Package Information

An intervention package is not available at this time. Please contact Dr. Neil S. Wenger, UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, RM 309, Los Angeles, CA 90095-1736. email: nwenger@mednet.ucla.edu for details on intervention materials.

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Evaluation Study and Results

The original evaluation was conducted in Los Angeles in 1988.

Key Intervention Effects

  • Reduced unprotected sex with last partner

Study Sample
The analytic study sample of 186 STD clinic patients is characterized by the following:

  • 88% African American, 12% Other
  • 67% Male, 33% Female
  • 100% heterosexual
  • Mean age of 27 years, range: 18-66 years
  • 84% completed high school education

Recruitment Settings
Inner-city STD clinic

Eligibility Criteria
STD clinic patients were eligible if they were over 18 years of age, not homosexual or bisexual, able to speak English, and able to provide a follow-up address for the follow-up questionnaire to be mailed to them.

Assignment Method
Participants (N = 256) were randomly assigned to 1 of 2 groups: AIDS education + HIV testing intervention (n = 125) or AIDS education only comparison (n = 131).

Comparison Group
The comparison group received the same AIDS educational module as the intervention group, but not the on-site HIV testing. They were offered a list of locations for free anonymous HIV antibody testing.

Relevant Outcomes Measured and Follow-up Time
Sex behaviors during the past month (including the number of sex partners, the number of episodes of vaginal and anal intercourse and of oral sex with and without a condom with all sex partners, and the number of sex acts with the most recent partner) were assessed at least 8 weeks post baseline, which translate to approximate 6 weeks after intervention.

Participant Retention

  • AIDS Education + HIV testing:
    72% retained at approximately 6 weeks after intervention
  • AIDS Education only:
    74% retained at approximately 6 weeks after intervention

Significant Findings
Intervention participants were significantly more likely than comparison participants to report having avoided vaginal or anal intercourse without a condom with their last sexual partner at 6 weeks after intervention (p = .05).

Considerations

  • This intervention fails to meet the best-evidence criteria due to a short follow-up time.
  • At 6 weeks after intervention, a significantly greater percentage of intervention participants used a condom, had only oral sex, or stated that they knew their partner’s HIV serostatus was negative compared to comparison participants (p < .003). The difference between the groups in protected sexual activity was greater when knowledge of a partner’s risk factors was taken into account.
  • Although both intervention and comparison groups received the AIDS Education module, the intervention effect should be considered in the context of AIDS Education and HIV testing combined rather than HIV testing only.
  • This two-session AIDS Education + HIV testing intervention is similar to the more current HIV testing protocols described in the RESPECT project (see 2-session brief intervention). The RESPECT brief counseling intervention, which meets the best-evidence criteria, is theory-based, includes goal setting and exercises, was evaluated using a more rigorous design, larger sample size, more diverse sample, and had stronger intervention effects. The intervention package and training are available for the RESPECT brief intervention through CDC’s REP and DEBI projects.

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References and Contact Information

  • Wenger, N. S., Linn, L. S., Epstein, M., & Shapiro, M. F. (1991). Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: A randomized clinical trial. American Journal of Public Health, 81, 1580-1585.

Researcher: Dr. Neil S. Wenger
UCLA Division of General Internal Medicine and Health Services Research
911 Broxton Plaza, RM 309
Los Angeles, CA 90095-1736
email: nwenger@mednet.ucla.edu

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