The Research
The Science Behind the Package
Personalized Cognitive Counseling (PCC) is a
single session counseling intervention
designed to reduce high-risk behaviors among
men who have sex with men (MSM) who are
repeat testers for HIV. The PCC
intervention is based on the work of
cognitive psychologist Ron Gold and
colleagues, hypothesizing that the decision
to engage in high-risk sex happens when the
person rationalizes the potential risk by
minimizing the known risk.
Target Population
PCC is for MSM who are HIV-seronegative, who have
had at least one HIV test before, and who report unprotected anal intercourse (UAI)
in the past 12 months with a partner of unknown HIV serostatus or a partner who
was HIV-positive. The intervention is for men 18 years of age or older of any
race/ethnicity.
Intervention
PCC is delivered in the context of HIV test
counseling in a 30 to 50 minute individual session. Typically the setting is a
community HIV testing site. Counselors should be trained in HIV prevention
counseling and testing and have at least one year of experience conducting HIV
counseling. The process is aided by the PCC
Questionnaire, a list of self-justifications that men often use to rationalize
risky behavior. PCC is a five step process: 1) The
client is assisted to recall a memorable episode of UAI. 2) The client completes
the PCC Questionnaire with the specific incident in
mind. 3) The counselor draws out the client’s story about the incident, along
with the thoughts and feelings the client experienced. 4) The counselor helps
the client identify the self-justifications that facilitated the UAI. 5) The
counselor asks the client what he will do in future similar situations to avoid
risk.
Research Results
Two controlled studies of PCC were conducted at the
AIDS Health Project (AHP) in San Francisco. In the first study, participants
were 248 MSM eligible for PCC. Two intervention groups
received standard HIV test counseling plus the PCC
cognitive behavioral intervention, delivered by mental health professionals, and
two control groups received only standard HIV test counseling. A second similar
study tested PCC versus standard HIV test counseling
using experienced bachelors-level HIV test counselors who were trained in the
PCC intervention. Participants were 336 MSM who were randomly
assigned to PCC or standard HIV counseling in the
second study. In both studies, the PCC intervention
significantly reduced the number of UAI episodes with non-primary HIV-positive
or unknown status partners in the six months after counseling. In the first
study, the average number of unsafe episodes significantly declined by about
half at six month follow-up and maintained 12 months later. Men who participated
in the second study were asked how helpful they found the services; those who
received PCC were more satisfied with the services
received.
For Details on the Research Design
Dilley JW, Woods WJ, Sabatino J, Lihatsh T, Adler B, Casey S, et al. (2002).
Changing Sexual Behavior Among Gay Male Repeat Testers for HIV: A Randomized,
Controlled Trial of a Single-Session Intervention, Journal of Acquired
Immune Deficiency Syndromes, 30(2), 177-86.
Dilley JW, Woods WJ, Loeb L, Nelson K,
Sheon N, Mullan, J, et al. (2007). Results
From a Randomized Controlled Trial Using
Paraprofessional Counselors. Journal of
Acquired Immune Deficiency Syndromes,
44(5), 569-577.
The InterventionA Package
Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that supports the translation of evidence-based HIV/AIDS prevention interventions into everyday practice, by working with the original researchers in
developing a user-friendly package of
materials designed for prevention providers.
PCC is one of the REP
interventions. The PCC
intervention package is the product of
extensive collaboration among researchers,
training developers, community service
providers, and community-based agencies. The
intervention has been field tested in two
community agencies by non-research staff.
Core Elements
Core Elements are intervention components that must be maintained
without alteration to ensure program effectiveness.
The core elements of
PCC include:
- Provide one-on-one counseling focusing on a recent, memorable high risk
sexual encounter.
- Provide the service with counselors trained in HIV counseling and testing
and in the PCC intervention.
- Use the questionnaire specifically tailored to identify key self
justifications used by clients in the target population.
- Using the questionnaire and discussion, identify specific
self-justifications used by clients in making the decision to engage in
specific high-risk behavior.
- Explore the circumstances and context for the risk episode in detail
(before, during and after).
- Clarify how the circumstances and self-justifications are linked to the
decision to engage in high-risk behavior.
- Guide the clients to re-examine the thinking that led to their decision to
have high-risk sex and identify ways they might think differently, and
therefore have protected sex in future potentially risky situations.
Package Contents
PCC Implementation Manual with guidance and
materials for implementation.
Timeline for Availability
The package is available from CDC along with training on program implementation and technical assistance.
For More Information on the PCC
Intervention Package
To find out more about future trainings, please visit
http://effectiveinterventions.org.
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