Program

Sep 22, 2014

OVERVIEW

Healthy Choices is a clinic-based intervention that aims to reduce risk behaviors, including unprotected sex, among teens living with HIV.  In an experimental study, teens in a treatment group who received 10 weeks of Healthy Choices programming were compared to teens in a control group who received only standard care.  At the 15-month follow-up, there was a significant positive intervention impact for the frequency of unprotected sex.

DESCRIPTION OF PROGRAM

Target population: teens living with HIV

Healthy Choices is a clinic-based intervention that aims to reduce risk behaviors among teens living with HIV.  Specifically, depending on their entry screening, two of the three following risk behaviors are chosen for teens to work on during the program: substance use, problems with adherence to antiretroviral treatment for HIV, and unprotected sex.  However, this evaluation’s results focus on participants who were working on addressing unprotected sex. Healthy Choices was adapted from Positive Choices, an intervention addressing risk behaviors in HIV-positive adult men who have sex with men. For Healthy Choices, a mental health clinician works with each participant over four sessions spaced over 10 weeks.  The first two sessions are each devoted to one of the two risk behaviors, using motivational interviewing techniques, the clinician collects feedback on the risk behavior and builds motivation to begin and maintain behavioral changes.  In addition, the clinician helps the participant think about pros and cons of the behavior changes and develop a personalized behavior change plan.  In the last two sessions, the clinician reviews the personalized behavior change plan, monitors progress, offers encouragement, troubleshoots barriers to making behavior changes, and works with the participant to develop strategies to maintain their behavior changes and prevent them from re-engaging in risk behaviors.  The program has not been manualized.

EVALUATION OF PROGRAM

Chen, X., Murphy, D. A., Naar-King, S., & Parsons, J. T. (2011). A clinic-based motivational intervention improves condom use among subgroups of youth living with HIV. Journal of Adolescent Health49(2), 193-198.

Evaluated population: Participants were 142 youth ages 16-24 who were HIV-positive, engaged in unprotected sex, and could complete questionnaires in English.  They were a subset of the 188 youth participating in a study of Healthy Choices, all of whom were recruited from five adolescent HIV clinics in Baltimore, Detroit, Fort Lauderdale, Los Angeles, and Philadelphia.

Approach: Participants were randomly assigned to a treatment group (n=71) that received Healthy choices programming and standard multidisciplinary care or to a control group (n=71) that received on standard care.  Participants reported information using computer-assisted personal interviewing technology about the number of times they had unprotected sex before the beginning of the study and at 3-, 6-, 9-, 12-, and 15-month follow-up assessments.  Attrition was 19 percent, 14 percent, 19 percent, 19 percent, and 18 percent at 3-, 6-, 9-, 12-, and 15-month follow-up points.

Results: Three groups were created to describe participants’ sexual risk based on their patterns of condom use across assessment points: the persistent low sexual risk group (PLSR), or those who only had few (0-2) incidences of unprotected sex from baseline to the 15-month follow-up; the delayed high sexual risk group (DHSR), or those who had few (1-3) incidences of unprotected sex for most of the study but an increased frequency of unprotected sex between 12- and 15-month follow-ups; and high and growing sexual risk group (HGSR), or those who had a high (10 or more) number of incidences of unprotected sex and an increased frequency of unprotected sex over the course of assessments.  Treatment group participants were significantly more likely to be categorized as PLSR and significantly less likely to be categorized as DHSR.  However, there was no intervention impact on a participant’s likelihood to be categorized as HGSR.

There was also a significant reduction in the number of times a participant had unprotected sex between baseline and the 15-month follow-up among treatment group participants in the PLSR and HGSR, but not the DHSR group.

SOURCES FOR MORE INFORMATION

References

Chen, X., Murphy, D. A., Naar-King, S., & Parsons, J. T. (2011). A clinic-based motivational intervention improves condom use among subgroups of youth living with HIV. Journal of Adolescent Health49(2), 193-198.

KEYWORDS: Adolescents, High School, College, Co-ed, High-risk, Clinic/Provider-based, Counseling/Therapy, Condom Use and Contraception