Start Talking About Risks: Development of a Motivational Interviewing-Based Safer Sex Program for People Living with HIV

Abstract

The epidemiology of HIV infection in the US in general, and in the southeast, in particular, has shifted dramatically over the past two decades, increasingly affecting women and minorities. The site for our intervention was an infectious diseases clinic based at a university hospital serving over 1,300 HIV-infected patients in North Carolina. Our patient population is diverse and reflects the trends seen more broadly in the epidemic in the southeast and in North Carolina. Practicing safer sex is a complex behavior with multiple determinants that vary by individual and social context. A comprehensive intervention that is client-centered and can be tailored to each individual's circumstances is more likely to be effective at reducing risky behaviors among clients such as ours than are more confrontational or standardized prevention messages. One potential approach to improving safer sex practices among people living with HIV/AIDS (PLWHA) is Motivational Interviewing (MI), a non-judgmental, client-centered but directive counseling style. Below, we describe: (1) the development of the Start Talking About Risks (STAR) MI-based safer sex counseling program for PLWHA at our clinic site; (2) the intervention itself; and (3) lessons learned from implementing the intervention.

SafeTalk, a Multicomponent, Motivational Interviewing-Based, Safer Sex Counseling Program for People Living with HIV/AIDS: A Qualitative Assessment of Patients' Views

“…Clients also responded positively to exercises and narratives, which provided opportunities to build specific practical skills for practicing safer sex, including use of barrier methods and communication skills. These findings are consistent with components emphasized in many other ''prevention with positives'' programs [23][24][25]30 but suggest that 242 GOLIN ET AL.…”

“…38 The program emphasizes setting small realistic goals focused on harm reduction. 30 The 13-step protocol is summarized in Table 1.…”

“…MI is a client-centered yet directive counseling style and has been shown to improve health behaviors successfully, including risky sexual practices, by enhancing self-efficacy and motivation. 23,[30][31][32][33][34] Negotiation around risk dynamics and decisions about when and how to practice safer sex are complex, particularly for people living with HIV. As a result, a comprehensive intervention, such as MI, that can be tailored to each individual's circumstances, may be more likely to be effective at reducing risky behaviors among people living with HIV than are more standardized prevention messages that are sometimes seen as confrontational.…”

An evaluation of a brief motivational interviewing training course for HIV/AIDS counsellors in Western Cape Province, South Africa

“…DiIorio et al, 2003;Golin et al, 2006;Parsons, Golub, Rosof, & Holder, 2007) and for HIV risk reduction in both HIV-negative and positive populations (e.g. Belcher et al, 1998;Golin et al, 2007;Naar-King et al, 2006). In South Africa, MI has successfully been used as part of an intervention to reduce sexual risk behaviours in clients attending an STI clinic (Simbayi et al, 2005).…”

Influencing Risk Behavior of Sexually Transmitted Infection Clinic Visitors: Efficacy of a New Methodology of Motivational Preventive Counseling

“…This is in accordance with the findings for an interview study with client of an STI clinic who received MI-based counseling. 33 These clients indicated that they considered the approach to be respectful and nonjudgmental. A further major advantage of MI-based counseling was the way in which MI-based, effective counseling can be introduced in real-life STI clinics.…”