- • Effective counseling to prevent sexually transmitted
diseases (STDs), including HIV, comprises the following elements:
- • Conducting a thorough risk assessment using exploring,
- • Addressing barriers to risk reduction and supporting
preventive actions already taken.
- • Addressing misconceptions.
- • Selecting with the patient a high-risk behavior
he or she is most willing and able to change.
- • Developing a step-wise risk reduction plan.
- • Providing referrals if needed.
Education and counseling have historically played a role in STD
prevention activities, usually as an adjunct to testing, treatment,
and partner notification services. However, it was not until the advent
of the HIV epidemic that behavioral interventions, including counseling,
became the focus of systematic efficacy research. A detailed review
of this research and its underlying theoretical considerations is
outside the scope of this chapter. However, arguably the single
most important study that put counseling to reduce sexual risk behaviors
on the map as an effective and feasible intervention for use in
a variety of settings was Project Respect. This randomized controlled
trial demonstrated that a specific type of counseling (subsequently
referred to as prevention counseling), comprising two 20-minute
counseling sessions, was significantly more effective in preventing
subsequent STDs when compared with standard prevention messages.
The findings of this study have important consequences for STD
prevention, especially because the effects of prevention counseling
were shown to be particularly favorable for populations at highest
risk for STDs, including individuals younger than 20 years of age
and those with a baseline STD. Thus, there is a strong rationale
to include counseling to reduce sexual risk behaviors when providing
care for persons at high risk for STDs—that is, as long
as the counseling process adheres to a number of critical elements.
Subsequent sections of this chapter describe these elements and
suggest ways in which prevention counseling can be incorporated
into a busy practice setting where time and resources are important
Kamb ML, Fishbein M, Douglas JM Jr, et al. Efficacy
of risk reduction counseling to prevent human immunodeficiency virus
and sexually transmitted diseases: A randomized controlled trial. Project
RESPECT Study Group. JAMA
(Landmark randomized controlled trial demonstrating
the superiority of counseling over brief educational messages in
the reduction of sexual risk behavior and subsequent STDs in persons
attending STD clinics.)
Guidelines for HIV prevention counseling have been put forth
by the Centers for Disease Control and Prevention (CDC) since 1986.
Prevention counseling as evaluated in Project Respect (sometimes
also referred to as client-centered counseling) was first described
in 1993 and updated most recently in 2001. An adapted summary of
these guidelines appears in Table 27–1, and a more detailed
Table 27–1. Principles of Prevention Counseling. |Favorite Table|Download (.pdf)
Table 27–1. Principles of Prevention Counseling.
|Keep session focused on HIV or STD risk reduction...|