title: The impact of a brief motivational intervention on unprotected sex and sex while high among drug-positive emergency department patients who receive STI/HIV VC/T and drug treatment referral as standard of care.
abstract: This randomized, controlled trial, conducted among out-of-treatment heroin/cocaine users at an emergency department visit, tests the impact on sexual risk of adding brief motivational intervention (B-MI) to point-of-service testing, counseling and drug treatment referral. 1,030 enrollees aged 18-54 received either voluntary counseling/testing (VC/T) with drug treatment referral, or VC/T, referral, and B-MI, delivered by an outreach worker. We measured number and proportion of non-protected sex acts (last 30 days) at 6 and 12 months (n = 802). At baseline, 70% of past-30-days sex acts were non-protected; 35% of sex acts occurred while high; 64% of sexual acts involved main, 24% casual and 12% transactional sex partners; 1.7% tested positive for an STI, and 8.8% for HIV. At six or 12 month follow-up, 20 enrollees tested positive for Chlamydia and/or Gonorrhea, and 6 enrollees HIV sero-converted. Self-reported high-risk behaviors declined in both groups with no significant between-group differences in behaviors or STI/HIV incidence.
authors.affiliation: Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, 1 Boston Medical Center Place (Dowling 1), Boston, MA 02118, USA. ebernste@bu.edu
authors.forename: Edward
authors.initials: E
authors.lastname: Bernstein
authors.forename: Desiree
authors.initials: D
authors.lastname: Ashong
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Michael
authors.initials: M
authors.lastname: Winter
authors.forename: Caleb
authors.initials: C
authors.lastname: Bliss
authors.forename: Guillermo
authors.initials: G
authors.lastname: Madico
authors.forename: Judith
authors.initials: J
authors.lastname: Bernstein
mesh_terms: D000293:Adolescent; D000328:Adult; D001900:Boston / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D037001:Directive Counseling / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009042:Motivation; D012017:Referral and Consultation; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology*; D047568:Unsafe Sex; D055815:Young Adult