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