Context.— The efficacy of counseling to prevent infection with the human immunodeficiency
virus (HIV) and other sexually transmitted diseases (STDs) has not been definitively
shown.
Objective.— To compare the effects of 2 interactive HIV/STD counseling interventions
with didactic prevention messages typical of current practice.
Design.— Multicenter randomized controlled trial (Project RESPECT), with participants
assigned to 1 of 3 individual face-to-face interventions.
Setting.— Five public STD clinics (Baltimore, Md; Denver, Colo; Long Beach, Calif;
Newark, NJ; and San Francisco, Calif) between July 1993 and September 1996.
Participants.— A total of 5758 heterosexual, HIV-negative patients aged 14 years or
older who came for STD examinations.
Interventions.— Arm 1 received enhanced counseling, 4 interactive theory-based sessions.
Arm 2 received brief counseling, 2 interactive risk-reduction sessions. Arms
3 and 4 each received 2 brief didactic messages typical of current care. Arms
1, 2, and 3 were actively followed up after enrollment with questionnaires
at 3, 6, 9, and 12 months and STD tests at 6 and 12 months. An intent-to-treat
analysis was used to compare interventions.
Main Outcome Measures.— Self-reported condom use and new diagnoses of STDs (gonorrhea, chlamydia,
syphilis, HIV) defined by laboratory tests.
Results.— At the 3- and 6-month follow-up visits, self-reported 100% condom use
was higher (P<.05) in both the enhanced counseling
and brief counseling arms compared with participants in the didactic messages
arm. Through the 6-month interval, 30% fewer participants had new STDs in
both the enhanced counseling (7.2%; P = .002) and
brief counseling (7.3%;P=.005) arms compared with
those in the didactic messages arm (10.4%). Through the 12-month study, 20%
fewer participants in each counseling intervention had new STDs compared with
those in the didactic messages arm (P = .008). Consistently
at each of the 5 study sites, STD incidence was lower in the counseling intervention
arms than in the didactic messages intervention arm. Reduction of STD was
similar for men and women and greater for adolescents and persons with an
STD diagnosed at enrollment.
Conclusions.— Short counseling interventions using personalized risk reduction plans
can increase condom use and prevent new STDs. Effective counseling can be
conducted even in busy public clinics.