Efficacy of Risk Reduction Counseling to Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases: A Randomized Controlled Trial, Mary L. Kamb et al., 280 JAMA 1161 (1998)

This paper discusses one of the first studies to report that interactive HIV/STD counseling leads to a reduction in the incidence of such STDs as gonorrhea, chlamydia, and syphilis (and, by inference, HIV). From 1993 to 1995, Project RESPECT, in collaboration with the Centers for Disease Control, invited heterosexual, HIV-negative patients aged 14 years or older who came to five public STD clinics across the country (Baltimore, MD; Denver, CO; Long Beach, CA; Newark, NJ; and San Francisco, CA) to participate in the study. 5758 patients (43%) enrolled and were then randomly assigned to one of four intervention arms: “enhanced counseling” consisting of four interactive theory-based sessions; “brief counseling” consisting of two interactive risk-reduction sessions; and finally, the last two arms each received brief “didactic messages” typical of current care. The first three arms received quarterly questionnaires for one year in addition to STD tests at 6 and 12 months. According to the study’s data, interactive and client-centered counseling resulted in an overall reduction in STD incidence of about 30% after 6 months and 20% after 12 months of follow-up. Based on these results, the article suggests that the greatest disease reduction benefit occurs during the first six months of counseling, yet also points out that counseling could have long-range benefits as well, given that STD reduction would diminish disease prevalence in the community at large; decrease vulnerability to HIV acquisition and transmission, which is often enhanced by the presence of STDs; and possibly reduce one’s lifetime risk for contracting STDs, if the behavioral changes occur when the likelihood of infection is particularly high, such as during adolescence. Furthermore, the paper indicates that the “brief counseling” model, which was specifically designed for low cost implementation in busy public clinics, would not only help to prevent new STDs, but also have at least the same retention as the didactic approach, while claiming a greater retention than longer therapies.

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