Abstract #207  -  Development and Pilot Testing of an HIV Risk-Reduction Intervention Tailored for HIV-Positive Women and Men in Clinical Care in KwaZulu-Natal, South Africa
Authors:   Presenting Author:   Dr. Paul Shuper - 1) Centre for Addiction and Mental Health; 2) University of Toronto
Additional Authors:  Dr. Deborah Cornman, Ms. Susan MacDonald, Ms. Sarah Christie, Dr. Janet Frohlich, Ms. Laramie Smith, Ms. Lindsay Shepherd, Ms. Gethwana Mahlase, Dr. Sandy Pillay, Ms. Zandile Jojo, Ms. Fikile Quvane, Dr. Umesh Lalloo, Dr. William Fisher, Dr. Jeffrey Fisher,
Aim: South Africa continues to be particularly affected by the HIV epidemic, with current antenatal estimates indicating a nationwide HIV prevalence of 28% (DOH SA, 2008). Within South Africa, the highest rates of HIV are found in the province of KwaZulu-Natal, with estimated prevalences exceeding 40% in some districts (DOH SA, 2008). The implementation of HIV risk-reduction interventions in these areas could have a significant impact on the spread of HIV, and interventions that specifically target individuals already infected with HIV may prove to be especially effective in this endeavor. The present investigation involved the development and pilot testing of an evidenced-based HIV risk-reduction intervention tailored for HIV-positive patients receiving care in KwaZulu-Natal, South Africa.
Method / Issue: Using the Information-Motivation-Behavioral Skills (IMB) Model (Fisher & Fisher, 1992) as a basis, and building on the empirically-validated US Options Intervention (Fisher et al., 2004), the Izindlela Zokuphila/Options for Health Intervention was developed specifically for the South African HIV clinical care context. It was designed as a counsellor-delivered intervention that employs motivational interviewing techniques to 1) assist HIV-positive patients to identify their specific barriers to safer sex, 2) assist patients to develop strategies for overcoming these barriers, and 3) empower patients to enact these risk-reduction strategies. This intervention was pilot tested with 40 HIV-positive patients (20 women, 20 men) receiving treatment at a rural KwaZulu-Natal clinic over the course of a three-month period.
Results / Comments: Six lay counselors trained in the Izindlela Zokuphila/Options for Health Intervention conducted a total of 74 intervention sessions with participating HIV-positive patients during the pilot trial. Barriers to safer sex frequently reported by participants during intervention sessions focused on 1) partner-related factors (e.g., having a partner who refused to use condoms, experiencing difficulty disclosing one’s HIV status to one’s partner, fear of distrust or abandonment if condom use was brought up with one’s partner); 2) condom-specific barriers (e.g., negative attitudes toward condoms, condom breakage); and 3) fertility desires (e.g., wanting to have a child). Risk-reduction strategies discussed during patient-counselor interactions involved maintaining consistent condom use over time (41.2%), implementing behavioural skills for safer sex (e.g., always having condoms available) (34.0%), and communicating with partners (e.g., discussing HIV counseling and testing) (11.3%). Post-intervention interviews with participants suggested high levels of comfort and trust when discussing challenging HIV prevention topics with counselors, and participants reported acquiring new information related to sexual risk reduction, motivation to practice safe sex, and behavioral skills to keep themselves and their partners safe. Additionally, lay counselors and clinic staff believed the intervention to be beneficial for their patients, reported that the intervention allowed patients to discuss safer sex-related issues in an open manner, and felt that the brief intervention sessions had only a minimal impact on clinic flow.
Discussion: The pilot test of the Izindlela Zokuphila/Options for Health Intervention demonstrates that 1) many South African HIV-positive patients continue to experience significant barriers to safer sex; and 2) brief, evidenced-based interventions that target these barriers can be feasibly implemented into an active South African clinical care setting.
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