Project RESPECT

OVERVIEW

Project RESPECT is a counseling program for teens and adults designed to prevent sexually transmitted diseases (STDs), including HIV, through condom use. Patients at a health clinic were randomly assigned to one of four conditions: enhanced counseling treatment group, brief counseling treatment group, didactic messages control group, or didactic messages with extended follow-up control group.

The intervention was found to impact incidents of new STDs as a whole, but was found to have no statistically significant impacts when looking at individual STDs (gonorrhea, Chlamydia, and HIV). The program did not impact men and women significantly differently, but was reported to be more effective for individuals aged 20 or younger. The two messages groups did not differ on diagnoses of gonorrhea, syphilis, or reports of condom use every time the respondent had intercourse.

DESCRIPTION OF PROGRAM

Target Population: individuals at urban health clinics being tested for STDs

Project RESPECT consists of one of two counseling interventions: brief counseling and enhanced counseling. The brief counseling intervention is modeled after CDC's recommendation for HIV counseling at health clinics. It attempts to help the patient identify behavioral risks and factors that keep them from reducing these risks. The patient and counselor decide on a plan to reduce risks. This includes two sessions. Session 1 is 20 minutes and occurs during the first visit to the clinic. Session 2 is also 20 minutes and discusses HIV test results.

The enhanced counseling is built on the theory of reasoned action and social cognitive theory and attempts to modify self-efficacy, attitudes, and perceived norms about condom use so that risk for HIV will be minimized. There are four sessions for this counseling condition. Session 1 is 20 minutes and occurs during the first clinic visit. Sessions 2 through 4 are 60 minutes each, and patients receive HIV test results in the third session. In each of the first three sessions, the patient and counselor come to an agreement on a small step to reduce risk through a behavior change. At the fourth session, the patient comes to a long-term plan for risk reduction.

Both didactic message groups were treatment-as-usual. The 2 sessions included 2 brief messages about STD prevention. The didactic messages with extended follow-up control group had their 2 sessions over 7 to 10 days. Like the brief counseling intervention and enhanced counseling, this control group returned for follow-up appointments 3, 6, 9, and 12 months after baseline.

The didactic messages control group also had their 2 sessions over 7 to 10 days and one follow-up visit 12 months after baseline.

EVALUATION OF PROGRAM:

Kamb, M.L., Fishbein, M., & Douglas, J.M., et al. (1998). Efficacy of risk-reduction counseling to prevent Human Immunodeficiency Virus and sexually transmitted diseases: A randomized controlled trial. Journal of the American Medical Association, 280(13):1161-1167.

Evaluated Population: Heterosexual patients at inner-city health clinics (N=5,833) ages 14 and older with negative baseline HIV test results were evaluated in this study. There were more men than women, 3,269 and 2,489 respectively. Of the participants, 59% were black, 19% were Hispanic, 16% were white, and 6% were another race. The median age was 25 years.

Approach: Patients were randomly assigned to receive enhanced counseling, brief counseling, or one of the didactic messaging control groups. In an attempt to approximate most STD clinics, patients in the didactic control group received two, five-minute clinician-delivered messages about HIV and STD prevention and were specifically not engaged in interactive counseling.

Laboratory tests were used to identify the STDs gonorrhea, Chlamydia, syphilis, and HIV. Interviewers asked about self-report condom use during vaginal sex, number of sex partners, risks of sex partners, and attitudes, self-efficacy, intentions, and perceived norms regarding consistent use of condoms.

Results: Use of condoms 100% of the time was significantly higher both 3 and 6 months after counseling in both treatment groups compared with the control group. Individuals in both of the two counseling treatment groups were significantly less likely to have developed a new STD compared with individuals in the didactic messages control groups. At 6 months, the treatment groups were 30% less likely than the control groups to have a new STD. At 12 months, they were 20% less likely. Men and women did not significantly differ from one another on STD reduction when comparing the counseling groups with the didactic messages groups. Incidences of gonorrhea, Chlamydia, and HIV (through the 12 month visit) did not significantly differ between the counseling groups and the didactic messages groups.

The two didactic messages control groups did not differ significantly on diagnoses of gonorrhea or syphilis and did not differ significantly in reports of "no episodes of unprotected vaginal sex."

The program was reported to be more effective for those 20 years of age and younger versus those older than 20, but the level of statistical significance was not reported.

SOURCES FOR MORE INFORMATION

Website: http://www.cdc.gov/hiv/topics/research/respect-2/index.htm

Manual: http://www.cdc.gov/hiv/topics/research/respect/pdf/bcim.pdf

References

Program categorized in this guide according to the following:

Evaluated participant ages: 14 years of age and older

Program components: clinic/provider based.

Measured outcomes: physical health.

KEYWORDS: Clinic-based, Sexual Activity, STD/HIV/AIDS, Adolescence (12-17), Young Adulthood (17-24), condom use and contraception, manual

		© Child Trends 2003