AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #155 - Systematic development of a computerised sexual risk reduction intervention with people living with HIV
Authors: Presenting Author: Dr Christiana Noestlinger - Institute of Tropical Medicine
Additional Authors: Ms. Tom Platteau, Dr. Daniela Rojas Castro, BA Matt Bristow, Dr. Agnes Kocsis,
Aim: Service providers’ needs for evidence-based counseling tools to support people living with HIV (PLHIV) in sexual risk reduction have been described repeatedly. This European study applies a systematic health promotion planning process, i.e. Intervention Mapping (IMM; Bartholomew et al., 2006) using six distinct steps for developing a theory- and evidence-based intervention to promote safer sex and condom use in PLHIV.
Method / Issue: In step 1, we carried out a needs assessment using qualitative and quantitative methods. We found a high need among service providers for easy-to-use tools and an overall proportion of 32% of PLHIV who reported at least one occasion of sexual risk (past 6 months). Safer sex behaviour was then linked with selected internal and external determinants (attitudes, motivation, self-efficacy, sexual decision-making, social support) for formulating behavioural goals for the intervention, expressed as proximal program objectives and individual change objectives (step 2). In step 3, theoretical methods were identified and translated into practical intervention strategies. The theoretical underpinnings were chosen from theories guiding our research, i.e. the information-motivation-behavioral skills model (Fisher&Fisher 1992), the stages of change theory (Prochaska 1992), and affective decision-making (Slovic et al, 2005). In step 4 they were converted into the counseling intervention (CISS or ‘computerised intervention for safer sex’). CISS facilitates developing a tailored risk reduction plan together with clients. In step 5 we adopted an implementation plan ensuring involvement of all stakeholders.
Results / Comments: CISS offers 3 counseling sessions: ‘Who am I’ is intended to engage clients at the emotional level by showing video material – talking heads, counseling scenarios and short ‘dramas’ – which identify problems with safer sex (mood, partner-related issues, use of alcohol/drugs, etc.). The second session ‘Working through’ focuses on shifting from the emotional to the rational self by identifying best-fit solutions linked to personal goals. The third session ‘Today and Tomorrow’ pinpoints the implementation of specific actions which have been identified as leading to the desired changes in behaviour. Currently, the CISS is implemented and evaluated (step 6) across a variety of European HIV care settings (10 sites). Adopting a randomized controlled trial to test the CISS’ effectiveness, 440 participants will be enrolled (currently about 40 patients are included). Outcome measure is increased condom use (three and six months follow-up) compared to the pre-intervention assessment of condom use.
Discussion: While IMM is labour-intensive and time-consuming, it helps to strengthen the theoretical foundation of this intervention, one of the factors believed to increase effectiveness (Crepaz & Marks 2006; Noar 2007). However, funding requirements (e.g. 3 year project period) don’t always allow for implementing the full cycle of adaptations based on IMM steps. Interpersonal and structural factors were identified as barriers to recruitment, such as social desirability in reporting unsafe sex behaviour in a clinical setting and criminalisation of unprotected sex (e.g. the case of Slovakia).
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