title: Clinic-based intervention reduces unprotected sexual behavior among HIV-infected patients in KwaZulu-Natal, South Africa: results of a pilot study.
abstract: OBJECTIVE
  To evaluate the feasibility, fidelity, and effectiveness of a human immunodeficiency virus (HIV) prevention intervention delivered to HIV-infected patients by counselors during routine clinical care in KwaZulu-Natal, South Africa.
  
  
  METHODS
  A total of 152 HIV-infected patients, aged 18 years and older, receiving clinical care at an urban hospital in South Africa, were randomly assigned to intervention or standard-of-care control counselors. Intervention counselors implemented a brief risk reduction intervention at each clinical encounter to help patients reduce their unprotected sexual behavior. Self-report questionnaires were administered at baseline and 6 months to assess number of unprotected sex events in previous 3 months.
  
  
  RESULTS
  Intervention was delivered in 99% of routine patient visits and included a modal 8 of 8 intervention steps. Although HIV-infected patients in both conditions reported more vaginal and anal sex events at 6-month follow-up than at baseline, patients who received the counselor-delivered intervention reported a significant decrease over time in number of unprotected sexual events. There was a marginally significant increase in these events among patients in the standard-of-care control condition.
  
  
  CONCLUSIONS
  A counselor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African clinical care setting and effective at reducing unprotected sexual behavior.
authors.affiliation: Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT 06269, USA. deborah.cornman@uconn.edu
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Cornman
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kiene
authors.forename: Sarah
authors.initials: S
authors.lastname: Christie
authors.forename: William A
authors.initials: WA
authors.lastname: Fisher
authors.forename: Paul A
authors.initials: PA
authors.lastname: Shuper
authors.forename: Sandy
authors.initials: S
authors.lastname: Pillay
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Friedland
authors.forename: Cyril M
authors.initials: CM
authors.lastname: Thomas
authors.forename: Linda
authors.initials: L
authors.lastname: Lodge
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisher
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010865:Pilot Projects; D040242:Risk Reduction Behavior; D012725:Sexual Behavior; D013019:South Africa; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000517:prevention & control*