Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 33272-33276 647

33272 Motivational enhancing and skills building HIV risk
reduction counseling intervention for women
Seth Kalichman', L. Belcher2, F. Norris2, J. Emsoff2, J.A. Nurss2. 'Center for
AIDS Intervention Research, Milwuakee, WI; 2892 Windfield Circle, Tucker, GA,
2Georgia State University, Atlanta, GA, USA
Objectives: To test the effectiveness of a brief HIV risk reduction counseling
intervention for women.
Design: Randomized clinical field trial with a time matched control arm; followed
over 1 and 3-months.
Methods: Women recruited from a high-AIDS prevalence area of Atlanta, GA,
USA who were sexually active and met screening criteria for recent high-risk sexual behavior (n = 74) completed baseline risk-assessment interviews and were
randomly assigned to one of two HIV prevention counseling interventions: (a) 120
min. multi-component and culture-gender tailored HIV risk reduction counseling
session that focused on motivational counseling techniques (Miller et al., 1992)
and cognitive-behavioral skills building (Kelly, 1995); or (b) 120 min. culture-gender
tailored basic AIDS education counseling session focusing on HIV transmission
education, HIV disease processes, and the pros and cons of HIV testing. The
same African-American female health counselors delivered counseling sessions
in both conditions. The assessments were conducted blind to intervention condition assignments. The majority (95%) of participants were African-American;
mean age was 34.9 years; 67% relied on government assistance for income.
Women were re-assessed at 30 days and again 90 days following the counseling
session; 92% of participants were retained throughout all follow-ups.
Results: Analyses of follow-up data showed that women who received motivational/skills building counseling reported significantly higher rates of condom
use during vaginal intercourse than women receiving educational counseling (p
S0.05). At baseline, women in the motivational/skills condition reported condom
use during 22% of intercourse occasions, which increased to 66% 90 days after
counseling, compared to 27% condom use for women in the education session
at baseline, increasing to 43% at 90 day follow-up.
Conclusion: Brief and focused motivational/skills building HIV risk reduction
counseling is an effective intervention strategy for women at high-risk for HIV
infection that can be readily implemented in direct services.
33273 HIV counseling and testing referrals given to high-risk
negatives increase prevention service use
Rani Marx1, D.S. Sebesta', A.M. Hirozawa1, Y. Liu', J.G. Kahn2, M.H. Katz2.
'San Francisco Public Health Department, San Francisco, CA; 2University of
San Francisco, anfrancisco, CA, USA
objective: HIV counseling and testing (HIV C & T) is the largest prevention
intervention in the US. A critical but poorly assessed component of HIV C & T
is referring high-risk negatives to additional prevention services. We evaluated
follow-through on HIV prevention referrals given to high-risk persons who test
seronegative.
Methods: Clients were enrolled at four confidential San Francisco test sites
if they were at high risk (i.e., men having sex with men [MSM], injecting drug
users [IDU], or women with high-risk partners, and not practicing safe sex or safe
injection in the past year), received seronegative test results, and were given at
least one HIV prevention service referral. We interviewed participants two to three
weeks after HIV C & T to determine perceived HIV risk, prior prevention service
use, referral recall, referral follow-through, barriers to follow-through, perceived
need for services, and intent to access services. The study is ongoing.
Results: From June to December 1997, 102 eligibles were identified, of whom
73 (72%) were enrolled. Of those enrolled, 38 (52%) were interviewed (29 were
not reached, 6 are still being contacted). Of those interviewed, 87% were MSMs,
10% were IDUs, and 3% were high-risk women. Most participants (84%) felt they
were at risk for HIV infection; 18% had accessed prevention services in the year
prior to testing. Almost all participants (95%) recalled one or more of the referrals
given; 16% accessed at least one referral since receiving test results, and an
additional 3% tried unsuccessfully to access services. Participants reported that
the most common barrier to getting services was being "too busy". For participants
who didn't access any services, 35% felt they needed the services, and 29%
intended to access the services in the coming month.
Conclusion: Our preliminary findings suggest that many high-risk negatives
who receive HIV C & T are open to other prevention services: most acknowledge
their risk and recall prevention referrals given; some will independently access
prevention services to which they have been referred. The effectiveness of HIV
C & T as a prevention intervention can be greatly improved by providing referrals
to high-risk seronegatives.
33274 Reducing HIV risk among low-income women using
motivational enhancement and behavioral skills training
Michael P. Carey', S.A. Maisto2, L.S. Braaten2, L.E. Durant2, A.D. Forsyth2,
B.C. Jaworski2, L.S. Weinhardt2. 14671 Bloomsbury Drive Syracuse NY 13215;

2Syracuse University Syracuse NY, USA
Objective: To determine whether a brief behavioral intervention designed to
enhance motivation and improve interpersonal skills can help low income urban
women to reduce their risk of acquiring HIV.
Design: Randomized clinical trial.
Methods: Street and community outreach were used to recruit 357 women,
each of whom completed a screening instrument designed to determine their risk

of HIV infection. Of the 140 women who were at risk for HIV infection, 102 agreed
to participate in the clinical trial. These women (mean age = 29 yrs; 88% AfricanAmerican) were randomly assigned to a 4 session HIV-risk reduction program (n
= 55), or to a structurally equivalent health promotion control group (n = 47) The
HIV program was based social-cognitive theory, and used motivational enhancement and skills training techniques in small groups. The control group presented
information related to diet, breast self-examination, stress, anger management,
and smoking. Groups were led by two trained female facilitators, and held at a
community-based organization with a long history of service to people of color.
Participants completed pre-, post-, and 3-month follow-up surveys that assessed
HIV-related knowledge, motivation, and behavior; surveys were identified by code
number to preserve anonymity. The results indicated that, relative to controls,
women in the HIV risk reduction group improved their knowledge regarding HIV
and expressed stronger intentions to adopt safer sexual practices. Women also
reported fewer occasions of unprotected vaginal intercourse over time.
Conclusion: Brief, group-based behavioral intervention based on social-cognitive theory can help disadvantaged women to increase HIV-related knowledge
and motivation, sharpen their relationship skills, and reduce their risk of infection
with HIV.
33275 CD4+ T lymphocytes counts of HIV infected women
seeking an anonymous counseling/testing service in Sao
Paulo, Brazil
Ana Beatriz Ungaro1, C.G. Luppi2, V. Buccheri3, E. Sabino4, J. Eluf-Neto2.
'Avenida Doutor Arnaldo, 445 20 Andar, Sao Paulo, SP, 2Dep. Prev.-Fac.
Medicina-USP Sao Paulo; 3FundaCao Maria Cecilia Souto Vidigal, Sao Paulo;
4Fundagao Pro-Sangue/Hemocentro S. Paulo, Sao Paulo, Brazil
Objective: To evaluate the time since infection of women seeking an anonymous
HIV counseling and testing service in Sao Paulo, Brazil.
Methods: A case-control study was conducted between May 1995 and December 1996 to investigate factors associated with HIV infection among women. This
study was developed in a public health service that provides anonymous HIV antibody testing and counseling in Sao Paulo, Brazil. Participants were interviewed by
using a structured questionnaire. Information obtained included sociodemografic
characteristics, sexual behavior and HIV risks. Women found seropositive had
blood samples collected and analyzed by two color immunofluorescence by using a standardized lysed whole blood staining technique to determine CD4+
T-lymphocytes count.
Results: CD4+ T-lymphocytes count analysis was performed in 69 women
found positive for HIV. The CD4 median was 320 cells/t1l in these women. Thirtyfive (51%) had less than 500 cells/plI (14 less than 200). Low CD4 counts were
significantly associated with higher condom use, sexual abstinence and weight
loss greater than 10% in the previous six months.
Conclusions: These results indicate that in Sao Paulo many women are
seeking an anonymous testing service late in the course of HIV infection. This
finding has important implications for the prevention of HIV transmission and the
prognosis of HIV infected women.
33276 Do women abandon condoms after exposure to a
safer-sex hierarchy?
Mary Latka', E.L. Gollub2, P.P. French3, Z.A. Stein4. 1New York Academy of
Medicine 1216 Fifth Ave Cues Room 556; 2Philadelphia Dept Public Health
Philadelphia PA; 3Smithkline BeeCham Inc. College Ville PA; 4New York State
Psychiatric Institute New York NY, USA
Objectives: To measure condom use (male and female) in a cohort of women
exposed to a safer-sex prevention hierarchy. To compare condom use between
this cohort and cohorts exposed to "condom only" counseling.
Methods: All women attending the main STD clinic in Philadelphia between
May 1, 1995 and April 12, 1996 (n-2100) were randomized to counseling in:
male condoms; female condoms; or a safer-sex hierarchy that included a choice
of male and female condoms, diaphragm and cervical cap, spermicides, and
withdrawal, ranked by potential effectiveness against STD/HIV. Three cohorts
(Male Condom n = 31; Female Condom n = 65; Hierarchy n = 74) were derived
from this trial by enrolling willing and eligible women for prospective follow up after
exposure to one of the three counseling messages. The main outcome measure
was the mean proportion of coital acts protected by male or female condoms at
six months post counseling.
Results: Hierarchy counseling attracted and retained women with prior difficulties using male condoms, while Male Condom counseling attracted and retained
women especially likely to use male condoms. In the Hierarchy cohort, compared
to pre-intervention levels (21%), the mean proportion of condom-protected coital
acts significantly increased at six months (66% p <.0005 during sex with steady
partners). This held among the subset of Hierarchy women using male condoms
at pre-intervention (53% to 88% p =.005) and during sex with casual partners
(37% to 85% p =.004). At six months, there were no significant differences in
condom use between the Hierarchy, Male Condom and Female Condom cohorts

(73%, 79% and 78% of coital acts with steady partners protected). The Male
Condom cohort achieved high levels of protection by abstaining from sex.
Conclusions: Hierarchy women did not abandon condoms. Rather, Hierarchy
counseling was associated with a long-term increase in condom use at levels
at least as high as that observed among women exposed to "condom only"
counseling. Moreover, differential selection, reporting, and attrition bias across
cohorts suggested that, relative to the full clinic population, observed condom