Joseph F. Picciano

A Telephone Based Brief Intervention Using Motivational Enhancement to Facilitate HIV Risk Reduction Among MSM: A Pilot Study

We conducted a randomized controlled pilot intervention to evaluate the efficacy of a telephone-based brief counseling intervention to reduce sexual risk taking among men who have sex with men (MSM) in Seattle, Washington. The study targeted individuals who were currently engaging in unsafe sex but were not committed to making changes toward safer behaviors. Counselors used motivational interviewing strategies in a single 90-min session to enhance readiness for change, promote greater intentions to use condoms, and to support safer sex practices. Results are based on 89 MSM randomly assigned to Immediate counseling or a Delayed counseling control condition. Among minority participants, Immediates were significantly less likely to have engaged in unprotected anal intercourse at follow-up, compared to Delays. Immediate participants reported significantly less ambivalence about practicing safer sex at follow-up, and tended to report greater increases in intentions to use condoms. These findings support the potential efficacy of a brief intervention based upon motivational enhancement principles for promoting safer sex practices among at-risk MSM.

RISK FOR HIV INFECTION AMONG BISEXUAL MEN SEEKING HIV-PREVENTION SERVICES AND RISKS POSED TO THEIR FEMALE PARTNERS

The present study interviewed gay (n = 473) and bisexual men (n = 146) as part of an HIV prevention program and investigated social cognitive factors associated with HIV risk. Results indicated that HIV risk in homosexual men was associated with sexual openness and connections to gay communities, factors not associated with risk for bisexual men. Compared with men at lower risk, those who practiced high-risk sex scored lower on measures of perceived safer sex norms, safer sex self-efficacy, and social skills. Bisexual men with primary female partners often had not disclosed their bisexuality to female partners (75%), and 64% had not modified their behavior to protect female partners. Bisexual men who engage in high-risk behaviors therefore pose a risk to female partners who may be unaware of their involvement with men.

Motivation to Reduce HIV Risk Behaviors in the Context of the Information, Motivation and Behavioral Skills (IMB) Model of HIV Prevention:

The Information-Motivation-Behavioral Skills (IMB) model of health behavior was tested in a sample of 391 men who have sex with men at high-risk for HIV transmission. Prospective analyses of IMB predictors of unprotected anal intercourse (UAI) confirmed a good fit. Self-rated motivation was a significant predictor of UAI, as were behavioral skills. However, the lack of information and motivational constructs that predicted behavior suggests that the IMB model is limited as a theory and has its greatest utility as a framework for guiding HIV risk reduction interventions for men who have sex with men at high-risk for HIV infection.

HIV-Prevention Group Counseling Delivered by Telephone: An Efficacy Trial with Gay and Bisexual Men

A 14-session cognitive-behavioral group counseling intervention designed to assist gay and bisexual males in reducing their risk of HIV transmission was evaluated in an experimental design. To overcome psychological and geographic barriers to serving individuals at risk, the counseling sessions and all data collection interviews were conducted via telephone. Participants had the option of enrolling anonymously, and a toll-free number was made available. At reassessment, treatment group participants were 80% less likely than controls to report any unprotected anal sex, and were nearly twice as likely to report some condom use with anal and oral sex. Treated participants also reported a significantly greater decline than controls in the proportion of anal sex acts that were unprotected by condoms. While those who were treated maintained a lower risk level over the year following treatment, their initial increase in condom utilization was not maintained. Delivering counseling interventions via the telephone, when coupled with the option for participating anonymously, holds considerable promise in overcoming barriers to reaching and effectively facilitating risk reduction in high-risk populations.

The check-up: in-person, computerized, and telephone adaptations of motivational enhancement treatment to elicit voluntary participation by the contemplator

Countless barriers come between people who are struggling with substance abuse and those charged with providing substance abuse treatment. The check-up, a form of motivational enhancement therapy, is a harm reduction intervention that offers a manner of supporting individuals by lowering specific barriers to reaching those who are untreated. The check-up was originally developed to reach problem drinkers who were neither seeking treatment nor self-initiating change. The intervention, marketed as an opportunity to take stock of ones experiences, involves an assessment and personalized feedback delivered with a counseling style termed motivational interviewing. Check-ups can be offered in care settings to individuals who, as a result of screening, manifest risk factors for specific disorders such as alcoholism. They can also be free-standing and publicized widely to the general public. This paper will discuss illustrations of in-person, computerized, in-school, and telephone applications of the free-standing type of check-up with reference to alcohol consumers, adult and adolescent marijuana smokers, and gay/bisexual males at risk for sexual transmission of HIV. The papers major focus is to highlight how unique features of each application have the potential of reducing barriers to reaching specific at-risk populations. Also considered are key policy issues such as how check-up services can be funded, which venues are appropriate for the delivery of check-up interventions, pertinent competency criteria in evaluating staff who deliver this intervention, how marketing can be designed to reach contemplators in untreated at-risk populations, and how a check-ups success ought to be defined.

Lowering obstacles to HIV prevention services: Effects of a brief, telephone-based intervention using motivational enhancement therapy

Background: Brief and low-burden HIV risk reduction counseling interventions are needed for populations at greatest risk for HIV infection.Purpose: This randomized controlled trial tested a brief theory-based counseling intervention delivered entirely over the telephone for men who engage in unprotected intercourse with men.Methods: Participants received either risk reduction counseling that included information, motivational enhancement and behavior skills building, or brief HIV education counseling. A total of 319 participants completed follow-up assessments over a 10-month period. Descriptive and random effects mixed models are used to evaluate findings.Results: Results demonstrate that a brief telephone intervention can reach and engage high-risk men in risk reduction counseling. Nearly one third of participants identified as men of color; the median age was 33 years. Participants in both counseling conditions increased their motivation and behavioral skills to practice safer sex and reduced their number of sex partners and frequencies of engaging in unprotected anal sex over the study observation period. However, there were few differences between intervention conditions.Conclusions: The effects of repeated measurement reactivity and brief interpersonal consciousness raising may account for the lack of differences between counseling conditions and the decrease in risk for all participants over time.

HIV Prevention and Attrition: Challenges and Opportunities

A sizable number of individuals at risk of becoming HIV infected or infecting others either do not access or drop out of AIDS prevention programs. Attrition is a relevant concern for HIV prevention research and practice alike as nonparticipation (enrolling in but never attending an intervention) and dropout (beginning but not completing an intervention) can affect internal and external validity, detrimentally impact the service providers morale and standing with funders, and potentially lead to poor outcomes for target populations. Understanding how individual factors including demographic and developmental characteristics and programmatic factors such as intervention dosage and venue are related to attrition and how to attract and retain individuals in proven interventions is crucial to prevention efficacy in the third decade of HIV prevention. In this paper, we provide an overview of factors associated with attrition from HIV counseling interventions, offer remedies for practitioners and researchers, and provide a case analysis of a brief motivational enhancement counseling intervention that was designed, in part, to avoid some of the traditional reasons individuals do not enroll in or drop out of HIV prevention programs.

Factors Associated with Attrition from an HIV-Prevention Program for Gay and Bisexual Males

Among 340 gay and bisexual males who enrolled in a 14-session HIV-prevention group counseling program delivered by telephone, 21.2% (n = 72) failed to attend any counseling sessions, 10% (n = 34) dropped out early, 18.9% (n = 64) dropped out late, and 50% (n = 170) completed counseling. Those who did not complete counseling tended to be younger, have lower levels of income, be less gay-identified, and experience logistical barriers to participation. Entering a new committed relationship after enrolling in the program was also associated with earlier attrition from treatment. Individuals with higher baseline levels of high-risk sexual behaviors, and those with lower motivation or confidence in changing, were not differentially vulnerable to attrition from the intervention. However, treatment completers reported more positive outcomes at follow-up relative to those who left the program. This finding underscores the importance of greater tailoring of preventive interventions in order to more successfully retain the non-gay-identified individual, and to reduce logistical impediments to participation. Other important implications pertain to countering possibly inaccurate risk perceptions concerning the absence of HIV transmission risk within committed relationships.

Motivational Enhancement Counseling Strategies in Delivering a Telephone-Based Brief HIV Prevention Intervention

Motivational enhancement therapy (MET) interventions are being increasingly added to the menu of behavioral interventions for HIV prevention. They present few logistical and psychological barriers for at-risk persons who are ambivalent about transmission risk reduction and appear to offer promise of being transferable to community based organizations and public health programs. We describe the principles of motivational interviewing, a counseling style often used in conjunction with MET, and demonstrate and discuss its application with case examples drawn from a recent pilot trial of a telephone-delivered brief motivational enhancement for HIV risk reduction with men who have sex with men (MSM).

The Sex Check: The Development of an HIV-Prevention Service to Address the Needs of Latino MSM.

Abstract The Sex Check is a brief, telephone-delivered, HIV-pre-vention intervention tailored for individuals who are at high risk of HIV infection or transmission but who are neither reducing their risk on their own nor seeking support for this purpose. Because the intervention is delivered on a one-to-one basis, permits anonymity, is marketed to “men who have sex with men,” and is brief, it may be particularly responsive to cultural, structural, and attitudinal barriers to serving Latino MSM. Because many Latino MSM continue to engage in high risk sexual behaviors, developing and testing prevention interventions with this population is a public health priority.