Personalized Cognitive Counseling
Personalized Cognitive Counseling (PCC) is an intervention designed to reduce risky sexual behaviors among men who have sex with men (MSM) who are repeat testers for HIV. PCC encourages clients to identify thoughts and feelings from a recent episode of condomless anal intercourse in order to reduce risk in future situations.
About Personalized Cognitive Counseling
Personalized Cognitive Counseling (PCC) is a 30- to 50-minute individual-level, single-session counseling intervention designed to reduce condomless anal intercourse (CAI) among men who have sex with men (MSM) who are repeat testers for HIV. PCC focuses on the self-justifications (thoughts, attitudes, and beliefs) used when deciding whether or not to engage in risky sexual behavior.
To reduce CAI among MSM who are at high risk for HIV.
Intervention Core Elements
- Provide one-on-one counseling focusing on a recent, memorable high-risk sexual encounter.
- Provide alongside HIV testing, counseling, case management, and primary care health services.
- Using the Checklist of Thoughts, identify specific self-justifications used to make the decision to have risky sex.
- Explore the circumstances and context, including any substances, for the risk episode (before, during, and after event).
- Clarify how these 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 CAI including their use of substances and to identify ways they might think differently in future situations.
To be eligible for PCC, the client must:
- be a man who has sex with men;
- have previously tested HIV-negative and not currently on PrEP;
- have had CAI since their last HIV test with a non-primary partner who was HIV-positive or unknown;
- be able to recall the CAI event; and
- know about HIV risk.
An adaptation of PCC for trans women who have sex with men, based on expertise from the Center of Excellence for Transgender Healthexternal icon and the Center for AIDS Prevention Studiesexternal icon at the University of California, San Francisco provides a sex-positive framework to reduce CAI among trans women.
Personalized Cognitive Counseling Training
The 2.5-day classroom training is intended for frontline staff who will conduct PCC with clients and have the following experience:
- Training as an HIV antibody test counselor.
- At least one year of experience as an HIV test counselor.
- Training and experience in a helping field (psychology, social work, counseling).
- Cultural competence and knowledge about MSM.
- Comfort with using everyday language to discuss sex.
- Familiarity with issues pertaining to substance use.
- Knowledge of community resources to make referrals.
The 1.5-hour online course is designed to give program administrators, supervisors, and health department monitors an overview of PCC.
To view and register for scheduled classroom trainings:
- Access the National HIV Classroom Learning Center training calendarexternal icon hosted on Cicatelli Associates, Inc.’s (CAI’s) website.
- Pre-register for your selected course via the link provided in the training calendar.
- Complete your registration on CDC TRAINexternal icon as directed when you receive an email from the National HIV Classroom Learning Center. You must join the HIV CBA Learning Group and locate the HIV CBA Training Plan in order to complete your CDC TRAIN registration for a specific classroom session (step-by-step instructionspdf iconexternal icon are available).
To access eLearning modules, including classroom training prerequisite courses:
- Log-in to CDC TRAINexternal icon and access the HIV CBA Training Plan (step-by-step instructionspdf iconexternal icon are available).
- Select the module you wish to take.
- Launch the module or save the module for later.
To request that a classroom training be scheduled:
- CDC’s directly funded health department and CBO partners may request delivery of a CDC-supported training by submitting a request in the CBA Tracking System.
- Organizations not directly funded by CDC may contact their local health department for assistance in submitting a training request.
Implementation and Marketing Materials
The materials and resources listed below support the implementation and/or marketing of Personalized Cognitive Counseling by health departments, community-based organizations, and health care or other organizations. The resources are evidence-based and designed for cost-effective, scalable implementation.
PCC is an evidence-based public health intervention. It has recently been adapted to address episodic substance use based on the findings of Project Echo. This randomized control trial demonstrated significant reductions in the number of CAI episodes with the three most recent non-primary partners among episodic substance-using MSM. The revised version of PCC addresses substance use and pre-exposure prophylaxis (PrEP).
- Coffin PO, Santos GM, Colfax G, Das M, Matheson T, DeMicco E, Herbst JH. Adapted personalized cognitive counseling for episodic substance-using men who have sex with men: A randomized controlled trial. AIDS Behav 2014 Jul;18(7): 1390-1400.
- Dilley JW, Woods WJ, Sabatino J, Lihatsh T, Adler B, Casey S, McFarland W. Changing sexual behavior among gay male repeat testers for HIV: A randomized, controlled trial of a single-session intervention. J Acquir Immune Defic Syndr 2002;30(2):177-186.
- Dilley JW, Woods WJ, Loeb L, Nelson K, Sheon N, Mullen J, McFarland W. Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: Results from a randomized controlled trial using paraprofessional counselors. Acquir Immune Defic Syndr 2007;44(5):569-577.