Relatively little is known about reducing HIV risk behavior among HIV+ persons, despite the fact that high levels of such behavior have been documented within the HIV+ population, and despite the fact that development of effective risk reduction interventions for HIV+ persons has been identified as a top NIH priority. The need to design effective interventions to reduce high risk behaviors among HIV+ individuals is pressing, since HIV+ persons who practice risky behaviors are certain sources of HIV risk to uninfected sexual and needle-sharing partners, and may transmit treatment resistant strains of HIV and other pathogens to HIV+ partners, and are themselves vulnerable to coinfection with other pathogens (e.g., STDs) through high risk behavior. Moreover, reducing high risk behavior among HIV+ persons is especially critical in the current era of highly active antiretroviral therapy (HAART). Because HAART may result in greatly increased health and lifespan for HIV+ persons, it also affords the possibility of transmitting HIV to others over greatly extended periods of time and may therefore enhance transmission of strains resistant to antiretroviral therapies (e.g., AZT, 3TC, and possibly HAART). The proposed research applies the Information--Motivation--Behavioral Skills (IMB) model of HIV risk behavior change to design a physician- delivered intervention to reduce HIV risk behavior among HIV+ adult men and women receiving care in HIV treatment settings. Standard treatment for HIV necessitates regular and frequent visits to clinical care settings, often resulting in close patient-clinician relationships. Thus, this setting is an exceedingly powerful context for prevention interventions for HIV+ individuals. The study will be conducted at two very comparable HIV clinics which together treat over 1800 HIV+ adults. On clinic will serve as an intervention site and one as a control site. The intervention will be designed and conducted by an experienced group of behavioral scientists and HIV clinical researchers. The overall goal of this program of research is to design, to implement, and to rigorously evaluate a conceptually based, easily disseminated, clinician- delivered intervention to promote HIV risk reduction among HIV+ adults receiving care in HIV treatment settings. This population is at enormous risk for transmitting HIV to others who are HIV-, and for acquiring other pathogens themselves and it is a population for whom there are few if any effective HIV risk reduction interventions.
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