Authors: Malotte, CK¹; Dillon, B²; Iatesta, M²; Douglas, JM, Jr³; Cross, H⁴; Metcalf CA²; Padilla, SM¹; and the RESPECT-2 Study Group

¹California State University Long Beach, Long Beach, CA; ²Centers for Disease Control and Prevention, Atlanta, GA; ³Denver Public Health, Denver, CO; ⁴New Jersey Department of Health and Senior Services, Trenton, NJ

Issue: HIV Prevention counseling seeks to reduce HIV/STD risk by means of a realistic personalized risk-reduction plan.

Setting: Public STD clinics in Long Beach, Denver, and Newark.

Project: RESPECT-2 is an ongoing multi-site randomized trial comparing the efficacy of 2 types of HIV prevention counseling. Both types of counseling focus on the participant’s risk behaviors, and assist the participant in developing a realistic risk-reduction plan. A computer-assisted self-interview on recent risk behavior is completed at 4 quarterly follow-up visits. The 3-month interview includes questions customized for each participant, assessing recall of the risk-reduction plan, success at achieving it, and barriers making it difficult to achieve. Those who do not correctly identify their plan are reminded what it was.

Results: Of the 2,366 participants who completed the interview, 66% correctly identified their plan. Most (92%) reported having tried their plan. Of those who tried, 69% reported being very (37%) or somewhat (32%) successful. Of those who reported success, most felt that their actions were very likely (60%) or likely (25%) to have reduced their risk. The most common barriers to achieving the plan were concern about partner’s reaction (12%), partner unsupportive (9%), participant discomfort (7%), and difficulty remembering the plan (6%). Compared to those who did not identify their plan correctly, a larger percentage of those who identified their plan reported trying to do the plan (95% vs. 88%, p<.001) and being successful (71% vs. 64%, p<.001). There were no differences by age group or gender in correctly identifying the plan, trying to do the plan, or success in doing the plan. However, females were more likely than males to report concern about partner reaction (15% vs. 10%, p<.001), and unsupportive partners (12% vs. 7%, p<.001) as barriers to completing the plan. African-Americans (63%) were less likely to correctly identify their plan than Latino (67%) or white (72%) participants (p<.001), and were somewhat less likely to think that the plan reduced their risk, but were similar on other measures.

Lessons learned: A majority of participants correctly identified their risk-reduction plan, had tried to achieve it, reported success, and felt this had reduced their risk. One-third of the participants did not identify their plan, however. Additional efforts should be focused on dealing with real or imagined partner resistance, and helping clients to remember their plans.