title: Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment.
abstract: OBJECTIVE
  To test the efficacy of brief, safer-sex counseling by medical providers of HIV-positive patients during medical visits.
  
  
  METHODS
  Six HIV clinics in California.
  
  
  METHODS
  Clinics were randomized to intervention arms evaluated with cohorts of randomly selected patients measured before and after the intervention.
  
  
  METHODS
  Five-hundred and eighty-five HIV-positive persons, sexually active prior to enrollment.
  
  
  METHODS
  Prevention counseling from medical providers supplemented with written information. Two clinics used a gain-framed approach (positive consequences of safer-sex), two used a loss-frame approach (negative consequences of unsafe sex), and two were attention-control clinics (medication adherence). Interventions were given to all patients who attended the clinics.
  
  
  METHODS
  Self-reported unprotected anal or vaginal intercourse (UAV).
  
  
  RESULTS
  Among participants who had two or more sex partners at baseline, UAV was reduced 38% (P < 0.001) among those who received the loss-frame intervention. UAV at follow-up was significantly lower in the loss-frame arm [odds ratio (OR), 0.42; 95% confidence interval (CI), 0.19-0.91; P = 0.03] compared with the control arm. Using generalized estimating equations (GEE) to adjust for clustering did not change the conclusions (OR, 0.34; 95% CI, 0.24-0.49; P = 0.0001). Similar results were obtained in participants with casual partners at baseline. No effects were seen in participants with only one partner or only a main partner at baseline. No significant changes were seen in the gain-frame arm.
  
  
  CONCLUSIONS
  Brief provider counseling emphasizing the negative consequences of unsafe sex can reduce HIV transmission behaviors in HIV-positive patients presenting with risky behavioral profiles.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Richardson
authors.forename: Joel
authors.initials: J
authors.lastname: Milam
authors.forename: Allen
authors.initials: A
authors.lastname: McCutchan
authors.forename: Susan
authors.initials: S
authors.lastname: Stoyanoff
authors.forename: Robert
authors.initials: R
authors.lastname: Bolan
authors.forename: Jony
authors.initials: J
authors.lastname: Weiss
authors.forename: Carol
authors.initials: C
authors.lastname: Kemper
authors.forename: Robert A
authors.initials: RA
authors.lastname: Larsen
authors.forename: Harry
authors.initials: H
authors.lastname: Hollander
authors.forename: Penny
authors.initials: P
authors.lastname: Weismuller
authors.forename: Chih-Ping
authors.initials: CP
authors.lastname: Chou
authors.forename: Gary
authors.initials: G
authors.lastname: Marks
mesh_terms: D000328:Adult; D002140:California; D015331:Cohort Studies; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000523:psychology*; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods; D021841:Safe Sex; D012747:Sexual Partners