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Am Fam Physician. 1999;59(3):669

The prevention of human immunodeficiency virus (HIV) infection is important since treatment, although improving, is still far from effecting a cure. Kamb and colleagues conducted this multicenter, randomized, controlled trial to determine whether counseling can prevent behaviors associated with an increased risk of contracting HIV and other sexually transmitted diseases (STDs).

Patients were recruited from inner-city STD clinics. Eligible patients were at least 14 years of age and were not HIV positive. Men who described themselves as homosexual or bisexual were excluded from the study. Patients were randomly assigned to one of four intervention groups: (1) enhanced interactive counseling, consisting of four counseling sessions (three of which were 60 minutes long) within four weeks of enrollment in the trial; (2) a brief interactive counseling intervention in two 20-minute sessions; (3) a noninteractive, didactic approach that stressed prevention in two five-minute sessions with follow-up appointments; and (4) a noninteractive didactic approach alone. The first three groups had scheduled follow-up appointments every three months for one year after enrollment.

Study subjects received free condoms and a relatively small financial incentive (no more than $45) for their participation. The study included 3,269 men and 2,489 women. The main outcomes observed by the authors were the participants' self-reported use of condoms and the occurrence of STDs in patients during the follow-up period. The assigned intervention sessions were completed by 82 percent of the participants.

All intervention groups reported improved rates of “no unprotected vaginal sex” and increased use of condoms at three and six months compared with baseline. Participants in the one-on-one intervention groups were significantly less likely to have unprotected sex than were patients in the didactic groups. By the nine- and 12-month follow-up visits, use of condoms in all groups was still more frequent than at baseline, but there were no significant differences among the groups. Patients in the two interactive intervention groups were less likely to develop STDs over the course of the study than were patients in the didactic groups. When the patients in the didactic group with follow-up were compared with the patients in the didactic group without follow-up one year after enrollment, it was discovered that the patients in the former group were less likely to engage in high-risk behaviors (such as unprotected vaginal sex).

The authors conclude that the incidence of STDs decreased by about 30 percent in the first six months of follow-up after interactive HIV/STD counseling. This figure dropped to about 20 percent after one year of follow-up but still shows the value of patient-centered, tailored counseling. The counselors in the trial typically did not have advanced degrees or long experience in interactive counseling; rather, they used personalized risk reduction plans to increase condom use and prevent new cases of STDs.

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Copyright © 1999 by the American Academy of Family Physicians.

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