Sexual Risk Reduction Counseling Research Articles

HIV pre-exposure prophylaxis awareness, practices, and comfort among urban and rural family medicine physicians.

HIV rates are increasing in rural areas, and adolescents are disproportionately affected. HIV pre-exposure prophylaxis (PrEP) is a daily pill that is effective at preventing HIV; however, PrEP uptake among adolescents is low. PrEP is dependent on primary care providers (PCPs) prescribing it, but research has overwhelmingly sampled urban PCPs. This study compared the PrEP awareness, practices, and comfort between rural and urban family medicine physicians. A total of 256 family medicine physicians in the United States were recruited from a Qualtrics panel to complete an online cross-sectional survey between July 15 and August 9, 2022. Participants completed items assessing their demographic characteristics and PrEP awareness, practices, and comfort. A chi-square test of independence and multiple logistic regression were used to determine rural/urban differences. Rural family medicine physicians were less comfortable than urban family medicine physicians in providing sexual risk reduction counseling to adolescents, telling an adolescent patient their HIV test result was HIV positive, and implementing all of the PrEP clinical activities for adolescents. Education, skill-building, and collaborative partnership interventions could improve the comfort levels of rural family medicine physicians in implementing the PrEP guidelines for their adolescent patients. Future research is needed to understand the factors that explain the differences in PrEP-related attitudes and practices between urban and rural family medicine physicians. Results from such studies could inform provider-based interventions that ultimately increase PrEP use and decrease HIV rates among rural adolescents.

Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Primary Care.

Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P < .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P < .001). Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.

Using Reproductive Health as a Strategy to Engage Youth in Preventive Care

PurposeThis research examined differences in receipt of recommended preventive services by contraceptive use in adolescent and young adult (AYA) women. MethodsData are from a retrospective chart review of 408 AYA women who received sexual health risk reduction counseling in an urban academic AYA clinic. Descriptive, bivariate, and logistic regression analyses were used to examine relationships between contraception use and receipt of care. ResultsAYA women aged 12–24 years using hormonal contraception were more likely to receive recommended preventive care, including an annual preventive visit and sexually transmitted infection screening, compared with those using condoms or no contraception. Women using medium-acting reversible contraception were more likely to have an annual visit compared with those not using hormonal contraception. ConclusionsAYA women using contraception are more likely to receive recommended preventive health services, suggesting reproductive health visits may be used to promote engagement around preventive care.

997. The Purview Paradox: PrEP Utilization at a Major Southern California County Teaching Hospital and Affiliated Clinics

BackgroundAccording to the Centers for Disease Control (CDC), PrEP coverage in the United States was approximately 18% in 2018 and 21.9% in California. We predict that PrEP prescription is lower at Harbor-UCLA Medical Center (HUMC) and affiliated clinics within Los Angeles County Department of Health Services.MethodsA retrospective chart review of HIV-negative patients with ICD-10 coded diagnoses of sexually transmitted infections (STIs) or high-risk sexual behavior was performed across various medical specialties at HUMC and affiliated clinics in 2018. Documentation of sexual behavior risk reduction counseling, PrEP discussion and prescription was reviewed from electronic medical records for each encounter. Descriptive statistics and analysis were completed in STATA Version 16.1, StataCorp LLC.ResultsThe sample included 250 individual patients, all with indications for PrEP. Of those, 47.2% identified as Latinx and 27.2% Black. Table 1 shows 74% of patients identified as heterosexual whereas 9.2% identified as gay, and 4.4% bisexual. Of the 250 individual patients, 87 (34.8%) returned for a 2nd visit, 35 (14.0%) for a third, and 9 (3.6%) for a 4th visit, for a total of 381 encounters. Of the total encounters, 49.3% had sexual behavior risk reduction counseling, 7.3% had discussions about PrEP with their provider, and only 2.1% were newly prescribed PrEP (Table 2). Of the 2.1% new PrEP prescriptions, 1.8% were prescribed by family medicine providers with no new prescriptions by OB/GYN or acute care providers. Only 25% of new PrEP prescriptions were female patients. A positive test for an STI occurred in 45.1% of total encounters while high risk sexual behavior was identified in 54.9% of encounters (Table 3).Table 1: First Encounter Demographics (N=250 Individual Patients) Table 2: Primary Outcomes by Specialty (N=381 Total Encounters) Table 3: Sexually Transmitted Infections Frequency (N=381 Total Encounters) ConclusionOur findings demonstrate that the percent of individuals newly prescribed PrEP (2.1%) at HUMC and affiliated clinics is less than that reported nationally and in California. This suggests that municipal health systems fall short in PrEP usage, notably for structurally vulnerable populations such as racial minorities as well as heterosexual females. Ending racial/ethnic disparities in HIV and in PrEP coverage not only requires educating specialty providers on PrEP, but also addressing structural racism and identifying structural barriers to care in vulnerable communities.Disclosures All Authors: No reported disclosures

Brief Enhanced Partner Notification and Risk Reduction Counseling to Prevent Sexually Transmitted Infections, Cape Town, South Africa.

Evidence-based interventions are needed to stem sexually transmitted infections (STIs). Clinic-delivered counseling remains an important avenue for effective STI prevention. A 3-arm randomized clinical trial compared (a) STI health education control condition, (b) risk reduction counseling, and (c) enhanced partner notification counseling. Men and women (n = 1050) were recruited from an STI clinic in Cape Town, South Africa. After baseline assessments, participants were randomly allocated to receive 1 of the 3 single-session counseling interventions and were followed up for 9 months of behavioral assessments and 12 months of electronic medical records abstraction for STI clinic services. Sexual risk reduction counseling reported greater condom use than did the other 2 conditions during the 3 and 6 months follow-ups. In addition, women receiving risk reduction counseling were significantly less likely to have returned for STI clinic services but did not differ in the number of STI clinic visits over the year. Brief single-session STI prevention counseling demonstrates significant targeted outcomes. The findings suggest that counseling approaches to both increase condom use and enhance partner notification may offer more robust and sustained outcomes and should be tested in future research.

Get In, Get Tested, Get Care: STD Services in Urban Urgent Care Centers.

Recent evidence indicates increased use of urgent care centers (UCCs) for sexually transmitted disease (STD) testing. We sought to learn more about STD services in UCCs in a large metropolitan area. Using a modified rapid gap assessment approach, we interviewed staff from 19 UCCs in metro Atlanta, GA. The UCCs were identified using two online search engines. We focused on a 50-mile radius around Atlanta. We then excluded duplicates and closed UCCs, and the ones outside Atlanta's five contiguous counties. Using a prioritization process, we visited UCCs in or adjacent to areas with mid to high local STD morbidity, or facilities from which STD cases were reported the year prior. We collected checklist-based data on STD testing, treatment, and preventive services, as well as supportive services (eg, substance use/mental health referrals). Checklist data, notes, and open-ended questions were summarized and analyzed descriptively. All UCCs (n = 19) reported offering basic to comprehensive STD testing. Although most could treat on-site for chlamydia and gonorrhea, most relied on referrals, or prescriptions and "return to facility" practices to treat syphilis. Sources for STD information/management included the health department/Centers for Disease Control and Prevention, online medical sites, and electronic medical record embedded information. Challenges UCCs acknowledged included staying up-to-date with treatment guidance and laboratory reporting requirements, inadequate time for sexual risk reduction counseling, and linking patients with extended care needs (eg, HIV+ case management, supportive services), or following up with patients. Urgent cares are STD testing resources. Service availability varies, but opportunities exist to enhance STD services in UCC settings and in communities.

An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men

ABSTRACTMen who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = −0.36; 95% CI: −0.69, −0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = −0.95; 95% CI: −1.44, −0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = −0.87; 95% CI: −1.38, −0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.

51. Unmet Need For Risk Reduction Counseling And Prep Among Young Women At Risk For HIV

Pre-exposure prophylaxis (PrEP) for HIV can reduce acquisition up to 96%. Women currently account for 20% of new HIV infections in the United States. The Centers for Disease Control and Prevention (CDC) recommends HIV counseling and testing services (CTS) for sexually active women diagnosed with a bacterial sexually transmitted infection (STI), and that PrEP be offered to women who have an HIV-positive sexual partner, engage in injection drug use (IDU), or who inconsistently use condoms with a partner of unknown HIV status. The purpose of this study is to evaluate provider sexual risk reduction counseling behaviors and adherence to HIV CTS and PrEP education/prescription guidelines. Data was extracted from the Women’s BioHealth Study, a longitudinal study of young women aged 13-29 years seeking routine gynecologic or obstetric care in pediatric, adolescent medicine, and obstetrics/gynecology clinics within a large academic medical center in Baltimore, Maryland. The STIs considered were Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV). Patients provided demographic and sexual risk data at baseline through a self-reported questionnaire and were notified of results. Eligibility criteria for inclusion in this analysis was: 1) a prior negative HIV test and 2) diagnosis of a bacterial STI, self-reported injection drug use, having an HIV seropositive partner, or inconsistent condom use with a partner of unknown HIV status. Assessment of documented provider HIV and STI risk reduction counseling behaviors were gathered from the Electronic Medical Record (EMR) using a standardized data extraction form. Descriptive statistics and logistic regression analyses were performed. Of the 688 patients enrolled, 23% (N=159) were positive for an STI (CT 10%, NG 5%, TV 38%, MG 62%). Among HIV-seronegative patients, 145 were eligible for PrEP counseling based on diagnosis of a bacterial STI (N=145) and/or self-reported injection drug use (N=3). Of the women eligible for PrEP intervention (N=145), the mean age was 21.5 years (SD 3.6), 92% were African American, 90% reported having one male partner, 6.9% reported consistent condom use, and 41% (N=60) were pregnant. STI treatment was documented for 55% of pregnant women and 80% of non-pregnant women. Non-pregnant women had 84.4 times the odds of receiving general risk reduction counseling compared to pregnant women (OR 84.4; 95% CI: 27.9, 255; p<0.001). Non-pregnant women under the age of 25 had 136 times the odds of receiving risk reduction counseling as compared to pregnant women over the age of 25 (OR 136; 95% CI: 34.08, 542.41; p<0.001). Only one woman (0.69%) eligible for PrEP counseling was offered PrEP. Young women seeking routine gynecologic and obstetric care have an unmet need for STI and HIV CTS and are rarely offered PrEP counseling. Pregnant women are particularly vulnerable for non-receipt of sexual risk reduction counseling and HIV CTS services and should be a targeted for intervention given the potential impact of recurrent or untreated STI diagnosis (including HIV) on maternal-child health outcomes.

A Pilot Randomized Controlled Trial of an Integrated In-person and Mobile Phone Delivered Counseling and Text Messaging Intervention to Reduce HIV Transmission Risk among Male Sex Workers in Chennai, India.

Men who have sex with men (MSM) are at increased risk for HIV infection in India, particularly those who engage in transactional sex with other men (i.e., male sex workers; MSW). Despite the need, HIV prevention efforts for Indian MSW are lacking. As in other settings, MSW in India increasingly rely on the use of mobile phones for sex work solicitation. Integrating mobile phone technology into an HIV prevention intervention for Indian MSW may mitigate some of the challenges associated with face-to face approaches, such as implementation, lack of anonymity, and time consumption, while at the same time proving to be both feasible and useful. This is a pilot randomized controlled trial to examine participant acceptability, feasibility of study procedures, and preliminary efficacy for reducing sexual risk for HIV. MSW (N=100) were equally randomized to: (1) a behavioral HIV prevention intervention integrating in-person and mobile phone delivered HIV risk reduction counseling, and daily, personalized text or voice messages as motivating "cognitive restructuring" cues for reducing condomless anal sex (CAS); or (2) a standard of care (SOC) comparison condition. Both groups received HIV counseling and testing at baseline and 6-months, and completed ACASI-based, behavioral and psychosocial assessments at baseline, 3, and 6months. Mixed-effects regression procedures specifying a Poisson distribution and log link with a random intercept and slope for month of follow-up was estimated to assess the intervention effect on the primary outcomes: (1) CAS acts with male clients who paid them for sex, and (2) CAS acts with male non-paying sexual partners-both outcomes assessed over the past month. The intervention was both feasible (98% retention at 6-months) and acceptable (>96% of all intervention sessions attended); all intervention participants rated the intervention as "acceptable" or "very acceptable." A reduction in the reported number of CAS acts with male clients who paid them for sex in the past month was seen in both study conditions. MSW in the intervention condition reported a faster rate of decline in the number of CAS acts with male clients in the past month from the baseline to both the 3-month (B=-1.20; 95% CI -1.68, -0.73; p<0.0001) and 6-month (B=-2.44; 95% CI -3.35, -1.53; p<0.00001) assessment visits compared to the SOC condition. Post-hoc contrasts indicated that, at 3months, participants in the intervention condition reported 1.43 (SD=0.29) CAS acts with male clients in the past month compared to 4.85 (SD=0.87) in the control condition (p=0.0003). Furthermore, at 6months, the intervention condition participants reported 0.24 (SD=0.09) CAS acts with male clients in the past month compared to 2.79 (SD=0.79) in the control condition (p<0.0001). Findings are encouraging and provide evidence of feasibility and acceptability, and demonstrate initial efficacy (for reducing sexual risk for HIV) of a behavioral HIV prevention intervention for Indian MSW that combines daily, personalized text or voice messages with mobile phone-delivered sexual risk reduction counseling and skills building. Future testing of the intervention in a fully powered randomized controlled efficacy trial is warranted.

Evaluating a novel intervention to reduce trauma symptoms and sexual risk taking: qualitative exit interviews with sexual minority men with childhood sexual abuse

Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.

A Randomized-Controlled Trial of Computer-based Prevention Counseling for HIV-Positive Persons (HPTN 065).

ObjectiveDecreasing the risk of HIV transmission from HIV-positive individuals is an important public health priority. We evaluated the effectiveness of a computer-based sexual risk reduction counseling intervention (CARE+) among HIV-positive persons enrolled in care.MethodsHIV-positive eligible participants (N=1075) were enrolled from 11 care sites in the Bronx, NY and Washington, DC and randomized 1:1 to either a tablet-based self-administered CARE+ intervention or standard of care (SOC). The primary outcome was the proportion of participants reporting any unprotected vaginal/anal sex at last sex, among all partners, HIV-negative or HIV-unknown-status partners and for primary and non-primary partners.ResultsAt baseline, 7% of participants in both arms reported unprotected sex with an HIV-negative or HIV-unknown-status partner, while 13% in the CARE+ arm and 17% in the SOC arm reported unprotected sex with any partner. Most participants (88%) were on antiretroviral therapy (ART) at baseline. There was no significant difference in changes over time in unprotected vaginal/anal sex between the CARE+ and SOC arms for any partners (p=0.67) or either HIV-negative or HIV-unknown-status partners (p=0.40). At the Month 12 visit, most participants (85%) either strongly agreed or agreed that computer counseling would be a good addition to in-person counseling by a provider.ConclusionThe CARE+ intervention was not effective at reducing sexual risk behaviors among HIV-positive patients in care, most of whom were on ART. Further research may be warranted around the utility of computer-based counseling for HIV prevention.

Implementation of a National Semen Testing and Counseling Program for Male Ebola Survivors - Liberia, 2015-2016.

According to World Health Organization (WHO) data, the Ebola virus disease (Ebola) outbreak that began in West Africa in 2014 has resulted in 28,603 cases and 11,301 deaths (1). In March 2015, epidemiologic investigation and genetic sequencing in Liberia implicated sexual transmission from a male Ebola survivor, with Ebola virus detected by reverse transcription-polymerase chain reaction (RT-PCR) 199 days after symptom onset (2,3), far exceeding the 101 days reported from an earlier Ebola outbreak (4). In response, WHO released interim guidelines recommending that all male survivors, in addition to receiving condoms and sexual risk reduction counseling at discharge from an Ebola treatment unit (ETU), be offered semen testing for Ebola virus RNA by RT-PCR 3 months after disease onset, and every month thereafter until two consecutive semen specimens collected at least 1 week apart test negative for Ebola virus RNA (5). Male Ebola survivors should also receive counseling to promote safe sexual practices until their semen twice tests negative. When these recommendations were released, testing of semen was not widely available in Liberia. Challenges in establishing and operating the first nationwide semen testing and counseling program for male Ebola survivors included securing sufficient resources for the program, managing a public health semen testing program in the context of ongoing research studies that were also collecting and screening semen, identification of adequate numbers of trained counselors and appropriate health communication messages for the program, overcoming Ebola survivor-associated stigma, identification and recruitment of male Ebola survivors, and operation of mobile teams.

Behavioral sexual risk-reduction counseling in primary care to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force.

Sexually transmitted infections (STIs) are common and preventable. To update a previous systematic review about the benefits and harms of sexual risk-reduction counseling to prevent STIs for the U.S. Preventive Services Task Force. Selected databases from January 2007 through October 2013, manual searches of references lists and gray literature, and studies from the previous review. English-language fair- or good-quality trials conducted in adolescents or adults. One investigator abstracted data and a second checked the abstraction. Study quality was dual-reviewed. 31 trials were included: 16 (n=56,110) were newly published and 15 (n=14,214) were from the previous review. Most trials targeted persons at increased risk for STIs based on sociodemographic characteristics, risky sexual behavior, or history of an STI. High-intensity (>2 hours) interventions reduced STI incidence in adolescents (odds ratio, 0.38 [95% CI, 0.24 to 0.60]) and adults (odds ratio, 0.70 [CI, 0.56 to 0.87]). Lower-intensity interventions were generally not effective in adults, but some approaches were promising. Although moderate-intensity interventions may be effective in adolescents, data were very sparse. Reported behavioral outcomes were heterogeneous and most likely to show a benefit with high-intensity interventions at 6 months or less. No consistent evidence was found that sexual risk-reduction counseling was harmful. Low-risk populations and male adolescents were underrepresented. Reliability of self-reported behavioral outcomes was unknown. High-intensity counseling on sexual risk reduction can reduce STIs in primary care and related settings, especially in sexually active adolescents and in adults at increased risk for STIs. Agency for Healthcare Research and Quality.

HIV testing and sexual risk reduction counseling in office-based buprenorphine/naloxone treatment

antagonist activity would prevent both stress and drug-induced reinstatement of extinguished cocaine-seeking behavior. Methods: In mice, we tested two putative mixed opioid agonist/antagonists, (−)pentazocine and the novel cyclic tetrapeptide cyclo[Ala-d-Pro-Phe-d-Trp] (Cmpd 1), for opioid efficacy and selectivity in the 55 ◦C warm-water tail-withdrawal assay, and then determined both compounds effects on the reinstatement of cocaine in a conditioned place preference (CPP) assay. Results: (−)Pentazocine and Cmpd 1 demonstrated equivalent efficacy in the tail-withdrawal assaywith ED50 (and 95% CI) values of 2.51(1.66–4.27) and 3.03(2.16–4.58) nmol, i.c.v., respectively. However, whereas (−)pentazocine antinociception was mediated by all three opioid receptors, the antinociception of Cmpd 1 appeared to be primarily mediated by KOR, with a small contribution by MOR. Pretreatment (10 nmol i.c.v., −3h) with Cmpd 1 selectively antagonized KOR, whereas (−)pentazocine primarily antagonized DOR. Surprisingly, while pretreatment (−3h/d, i.c.v.) with either compound dose-dependently prevented a 2-day stressinduced reinstatement, acute administration of Cmpd 1 but not (−)pentazocine blocked cocaine-induced reinstatement. Conclusions: Overall, these data suggest that with its distinct activity profile, compound 1 is a promising lead compound for potential development, particularly as a therapeutic to prevent relapse to drug seeking behavior in abstinent subjects. Financial support: Funding provided by NIDA (DA023924 and DA032928) and the State of Florida, Executive Office of the Governor’s Office of Tourism, Trade, and Economic Development.

A pilot RCT of an intervention to reduce HIV sexual risk and increase self-acceptance among MSM in Chennai, India.

This is a 2-arm pilot randomized controlled trial (N = 96) of a behavioral intervention (4 group and 4 individual sessions) integrating risk reduction counseling with counseling to foster self-acceptance in MSM in India compared to enhanced standard of care (ESOC). Both conditions involved HIV and STI testing and counseling at baseline and 6-months, and assessments of condomless sex at baseline, 3-, and 6-months. A significant condition by time interaction suggested a difference in the rate of change in number of anal sex acts without condoms in the intervention versus ESOC (p < 0.0001). Post hoc contrasts suggested that the overall difference was due to intervention-response at 3-months. The incidence of bacterial STIs was 17.5 % in the intervention condition and a 28.6 % in ESOC. Addressing self-acceptance and related psychosocial concerns in the context sexual risk reduction counseling for MSM in India was feasible and acceptable. Testing the intervention for efficacy is justified.

HIV Testing and Sexual Risk Reduction Counseling in Office-Based Buprenorphine/Naloxone Treatment

We assessed the feasibility and preliminary efficacy of human immunodeficiency virus (HIV) testing with sexual risk reduction counseling for opioid-dependent patients initiating office-based buprenorphine/naloxone treatment. We conducted a 14-week randomized, controlled trial with 30 patients (original target of 114) assigned to receive buprenorphine/naloxone induction/stabilization and HIV testing with Brief Sexual Risk Management (BSRM) or Enhanced Sexual Risk Management (ESRM). We evaluated process measures and compared outcomes at baseline and during the 3-month follow-up. Similar proportions of patients receiving BSRM and ESRM underwent HIV testing (93% vs 80%; P = 0.28) and completed counseling sessions (80% vs 67%; P = 0.40). Brief Sexual Risk Management sessions were shorter than ESRM sessions (15.4 vs 23.4 minutes), with comparable manual adherence (P = 0.80). Outcomes did not vary by BSRM versus ESRM. Although the recruitment of opioid-dependent patients with sexual risk behaviors is challenging, HIV testing with sexual risk reduction counseling in office-based buprenorphine/naloxone treatment practice is feasible. Interventions to decrease sexual risk behaviors among a segment of this population are necessary.

Project ART-ED: alcohol reduction and HIV testing in the emergency department

Unhealthy alcohol use and HIV risk often co-occur. To intervene on this association, we are conducting a pilot study to determine the feasibility and impact of providing brief alcohol- and sexual-risk reduction counseling with rapid HIV testing in a large urban emergency department (ED). We are recruiting ED patients aged 18-40 years who 1) meet National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking, 2) have >1 sexual-risk behavior, 3) have negative or unknown HIV status, and 4) are willing to undergo HIV testing. We are conducting a brief, manual-guided intervention combining an alcohol- and sexual-risk reduction counseling session with rapid HIV testing followed by a booster telephone call at two weeks. At baseline and eight weeks, we assess alcohol consumption with the Timeline Follow-Back for alcohol consumption and a modified HIV Risk Behavior Scale to characterize sexual risk behaviors. Statistical analyses include Wilcoxon Signed Rank test, McNemar test, and two-way ANOVA. Of the 82 participants enrolled to date, 60% are male, the mean age is 25 years, 63% are white, 83% are unmarried, 59% are college-educated, 41% are without primary care, and 79% have an AUDIT score of >8. All tested HIV negative. Among the 62 with follow-up data so far, alcohol consumption decreased with fewer average weekly drinks (25.5 versus 10.4, p < 0.0001) and binge drinking episodes (2.03 versus 0.99, p < 0.0001). This decrease was greater in men than women (p < 0.0002). Post-intervention, participants endorsed increased condom use (median change = 3 points on a 5-point scale, W = 275, p < 0.0001) and decreased episodes of sex while intoxicated (RR = 0.14, p < 0.0001). Mean intervention duration was 44 minutes. Preliminary analyses demonstrate that a brief intervention combining alcohol- and sexual-risk reduction counseling with rapid HIV testing in the ED is feasible and effective for reducing alcohol use and HIV risk behaviors among young unhealthy drinkers.

Sexual behavior among volunteers enrolled in a Phase I HIV vaccine trial: experience of Projet San Francisco in Kigali, Rwanda

Background Phase 1 HIV vaccine trials are conducted among HIVuninfected, healthy volunteers at low risk for HIV. Study volunteers are counseled to maintain low risk behavior for HIV acquisition. The objective of this study was to assess sexual behavior of volunteers in a Phase 1 vaccine trial, conducted in Kigali, Rwanda. Methods Concordant HIV-negative couples who were counseled and tested together were considered as low risk group for HIV acquisition and were invited to participate in Phase 1 HIV vaccine trial to evaluate safety and immunogenicity of a multiclade HIV-1 DNA plasmid vaccine followed by a recombinant, multiclade HIV-1 adenoviral vector vaccine (IAVI V001). HIV risk reduction counseling, assessment of sexual behavior and screening for sexually transmitted infections (STI) were conducted quarterly. After completion of the vaccine trial, participants and their partners were invited to participate in a long-term 5-year follow-up study from their last vaccination for further assessment of sexual behavior and continuous risk reduction counseling. Results

Combining Rapid HIV Testing and a Brief Alcohol Intervention in Young Unhealthy Drinkers in the Emergency Department: A Pilot Study

Background: We sought to determine the feasibility and impact of brief alcohol/ sexual risk reduction counseling with rapid HIV testing in the emergency department (ED). Methods: We recruited 18–40 year olds with unhealthy alcohol use, sexual risk behaviors, and negative/unknown HIV status and assessed for differences in their alcohol consumption and sexual risk behaviors at baseline versus 2 months. Results: Participants (n = 85) were 61% male, mean age 26 years old, 59% white, 92% unmarried, 57% college educated, 45% without a regular doctor, and 80% with an Alcohol Use Disorders Identification Test (AUDIT) score ≥8. All rapid HIV tests were negative. Among the 70 (82%) with follow-up, alcohol consumption decreased with fewer average weekly drinks (23.6 vs. 9.8, p = .003) and binge drinking episodes (2.0 vs. .9, p = .012). Post-intervention, sexual risk decreased, including increased condom use (23% vs. 46%, p = .007). Women had a greater decrease in alcohol use prior to sex compared with men (p = .021 for interaction). Conclusions: Alcohol/sexual risk reduction counseling with HIV testing in the ED is feasible and potentially effective for reducing alcohol use and sexual risk behaviors among young unhealthy drinkers. Scientific Significance: Future randomized controlled trials are warranted to assess efficacy of this intervention, which would provide young at-risk populations with important preventive services, which they may not have access to otherwise.

Implementing Rapid HIV Testing With or Without Risk-Reduction Counseling in Drug Treatment Centers: Results of a Randomized Trial

We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment. Between January and May 2009, we randomized 1281 HIV-negative (or status unknown) adults who reported no past-year HIV testing to (1) referral for off-site HIV testing, (2) HIV risk-reduction counseling with on-site rapid HIV testing, or (3) verbal information about testing only with on-site rapid HIV testing. We defined 2 primary self-reported outcomes a priori: receipt of HIV test results and unprotected anal or vaginal intercourse episodes at 6-month follow-up. The combined on-site rapid testing participants received more HIV test results than off-site testing referral participants (P<.001; Mantel-Haenszel risk ratio=4.52; 97.5% confidence interval [CI]=3.57, 5.72). At 6 months, there were no significant differences in unprotected intercourse episodes between the combined on-site testing arms and the referral arm (P=.39; incidence rate ratio [IRR]=1.04; 97.5% CI=0.95, 1.14) or the 2 on-site testing arms (P=.81; IRR=1.03; 97.5% CI=0.84, 1.26). This study demonstrated on-site rapid HIV testing's value in drug treatment centers and found no additional benefit from HIV sexual risk-reduction counseling.