The long-term objective of this research is to develop a feasible and effective HIV prevention strategy for use in publicly funded sexually transmitted disease (STD) clinics. Even though patients attending STD clinics are infected with HIV at alarmingly high rates, many do not know their HIV serostatus, decline HIV testing, and show limited interest in attending more intensive prevention programs. The proposed research will evaluate whether a two-step approach to HIV prevention, which is guided by behavioral science theory and features both motivational and skills components, achieves three important outcomes: (a) improved participation in HIV prevention services, (b) reduced risky sexual practices, and (c) decreased incidence of STDs. Women (n = 777) and men (n = 777) seeking care at a large, publicly-funded STD clinic will be recruited and provide informed written consent. Participants will complete a computer-administered survey at an initial clinic visit, and then will be randomly assigned to one of six intervention conditions. The six interventions will be formed by crossing a brief clinic-based component (two arms: brief motivational vs. brief informational) with a subsequent intensive component (three arms: skills-based vs. information-based vs. no treatment control). After completing both steps of the intervention, patients will be re-assessed at three, 6, and 12-month follow-ups using data obtained from observed participation in HIV prevention services, self-reported behavior, biological specimens, and medical records. Key dependent measures include short-term behavioral outcomes (agreeing to HIV testing, returning for HIV test results, and attending an intensive prevention program) and longer-term behavioral and biological outcomes (sexual risk behavior and incidence of STDs). The investigators predict that the brief motivational component will increase participation in HIV prevention services, and that the intensive skills-based component will reduce risk behavior and lead to fewer incident infections. It is also expected that patients receiving the motivational component will benefit most from the intensive component. The proposed research addresses a critical national and international HIV prevention priority, namely, motivating high-risk patients to engage in, and benefit from, HIV prevention services. The innovative use of a two-step approach, coupling motivational and behavioral skills components, will advance HIV prevention science and practice. ? ? ?
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