New nationwide study in six cities will look at the method & message for changing risky HIV behavior

July 12, 1999

A nationwide study being launched in six U.S. cities is designed to answer one of the major unknowns of the AIDS epidemic: What type of one-on-one counseling is most effective in changing high-risk behavior to prevent HIV infection?

The study is one of the first large-scale research projects to focus on this question. Conducted by the HIV Network for Prevention Trials and funded by the National Institute of Allergy and Infectious Diseases, it is being coordinated by a national team headed by AIDS researchers in San Francisco and New York.

"HIV prevention counseling programs have been widespread since 1985. A few studies have evaluated their impact, but none has directly compared different approaches. Our goal is to determine the most effective prevention counseling program, so in the future resources can be put to the best use," said Patrick Barresi, MPH, project coordinator and associate specialist in the Center for AIDS Prevention Studies (CAPS) at the University of California San Francisco.

Project co-chairs are Thomas Coates, PhD, executive director of the UCSF AIDS Research Institute and director of UCSF CAPS; Margaret Chesney, PhD, UCSF professor of medicine and co-director of UCSF CAPS; and Beryl Koblin, PhD, associate member, laboratory of epidemiology, New York Blood Center.

The study, named EXPLORE, will compare two behavior interventions: standard HIV risk reduction counseling based on a research model called Project Respect that was developed by the Centers for Disease Control and Prevention, and a client-centered counseling approach developed by Coates, Chesney, and Barresi of UCSF.

Study volunteers currently are being recruited in Boston, Chicago, Denver, New York City, San Francisco, and Seattle through local health centers and departments. Participants must be men who have sex with men, are HIV-negative, are at least 16 years old, and have been sexually active within the past 12 months.

Researchers hope to enroll 725 volunteers in each city, achieving a total study population of 4,350. Each participant will be randomly assigned to one of the intervention strategies and will be informed from the beginning of his group. The endpoint of the study will be a comparison of the HIV infection rate in each group after three years.

A major contrast in the two interventions is the emphasis on making a personal connection to the message, according to Barresi. "The conventional wisdom is that a personal approach will generate more client buy-in to changing behavior, but sexuality and sexual behavior are very private matters. It might be that a less personal discussion is 'safer' and therefore more effective. This is what we are going to find out," Barresi said.

Study participants assigned to the Project Respect strategy will serve as the control group, because this model already is being used. The message focuses on factual information and setting short-term goals for behavior change. Information will cover such topics as how HIV is transmitted and correct condom use. Sessions with a counselor are scheduled every six months, and counselors are assigned according to availability, so there is no guarantee a participant will have the same counselor at subsequent sessions.

Participants assigned to the UCSF approach will serve as the experimental group, because this intervention has not yet been tested. The message will focus on personal decision-making and setting long-term goals for reducing HIV risk. A participant will be shown a menu of relevant topics, choosing items that he would like to discuss at each session. Ten sessions are scheduled during the first four months, then additional counseling visits take place every three months for the rest of the three-year study period. A participant sees the same counselor each time.

In both intervention groups, participants will take part in individual counseling sessions with trained counselors and will be tested every six months for the presence of HIV antibody in the blood, an indication of HIV infection. If a participant does become HIV positive during the course of the study, he will be referred to appropriate followup services. All participants will receive payment.

"We know the key to controlling HIV infection rates is reducing high-risk behavior, but we need to know the best way to get this message across to a new generation of young adults who are sexually active. We designed our counseling approach as a way to talk with clients--not to them--about their high-risk behavior. The results of this study will tell us if we are going in the right direction," said Coates, who with Chesney is nationally recognized in HIV prevention efforts.

"With the UCSF approach, the client is a stakeholder in his future, and discussion covers real-life behavior options, such as ways to meet people and establish relationships without risk, personal strategies to reduce the risk of infection when using alcohol or drugs, and ways to communicate with partners about risk, safety, and most important, a future that will be free of infection," Chesney added.

The National Institute of Alcohol Abuse and Alcoholism also is providing funding for the study.
-end-
LOCAL SITES AND MEDIA CONTACTS ARE:

Boston
Fenway Community Health Center:
Tom LaSalvia - 617-927-6028, tlasalvia@fchc.org

Chicago
Howard Brown Health Center:
Brent Hope - 773-388-8860, brenth@howardbrown.org
Scott Cook - 773-388-8885, scottc@howardbrown.org
Fred Swanson - 773-388-8884, freds@howardbrown.org

Denver
Denver Department of Public Health:
Stephanie Denning - 303-436-6606, sdenning@dhha.org
Ken Miller - 303-367266, kgmiller@dhha.org


New York City
New York Blood Center:
Beryl Koblin - 212-570-3105, bkoblin@nybc.org
Denise Goodman - 212-388-0008, dgoodman@nybc.org


San Francisco
San Francisco Department of Public Health/AIDS Office:
Joe Wright - 415-554-9065, joe_wright@dph.sf.ca.us


Seattle
Seattle HIV/Net Site:
Dennis Torres - 206-521-5812, ditorres@u.washington.edu

University of California - San Francisco

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.