Cited by 973HIV/AIDS Research and InterventionsAdolescent Sexual and Reproductive HealthHIV, Drug Use, Sexual Risk

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Efficacy of Risk-Reduction Counseling to Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases: A Randomized Controlled Trial

Kamb, Mary L., Fishbein, Martin, Douglas, Jr, John M., Rhodes, Fen, Rogers, Judy, Bolan, Gail, Zenilman, Jonathan, Hoxworth, Tamara, Malotte, C. Kevin, Iatesta, Michael, Kent, Charlotte, Lentz, Andrew, Graziano, Sandra, Byers, Robert H., Peterman, Thomas A., for the Project RESPECT Study Group·1998·JAMA

DOI 10.1001/jama.280.13.1161

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Abstract

CONTEXT: The efficacy of counseling to prevent infection with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) has not been definitively shown. OBJECTIVE: To compare the effects of 2 interactive HIV/STD counseling interventions with didactic prevention messages typical of current practice. DESIGN: Multicenter randomized controlled trial (Project RESPECT), with participants assigned to 1 of 3 individual face-to-face interventions. SETTING: Five public STD clinics (Baltimore, Md; Denver, Colo; Long Beach, Calif; Newark, NJ; and San Francisco, Calif) between July 1993 and September 1996. PARTICIPANTS: A total of 5758 heterosexual, HIV-negative patients aged 14 years or older who came for STD examinations. INTERVENTIONS: Arm 1 received enhanced counseling, 4 interactive theory-based sessions. Arm 2 received brief counseling, 2 interactive risk-reduction sessions. Arms 3 and 4 each received 2 brief didactic messages typical of current care. Arms 1, 2, and 3 were actively followed up after enrollment with questionnaires at 3, 6, 9, and 12 months and STD tests at 6 and 12 months. An intent-to-treat analysis was used to compare interventions. MAIN OUTCOME MEASURES: Self-reported condom use and new diagnoses of STDs (gonorrhea, chlamydia, syphilis, HIV) defined by laboratory tests. RESULTS: At the 3- and 6-month follow-up visits, self-reported 100% condom use was higher (P<.05) in both the enhanced counseling and brief counseling arms compared with participants in the didactic messages arm. Through the 6-month interval, 30% fewer participants had new STDs in both the enhanced counseling (7.2%; P= .002) and brief counseling (7.3%; P= .005) arms compared with those in the didactic messages arm (10.4%). Through the 12-month study, 20% fewer participants in each counseling intervention had new STDs compared with those in the didactic messages arm (P = .008). Consistently at each of the 5 study sites, STD incidence was lower in the counseling intervention arms than in the didactic messages intervention arm. Reduction of STD was similar for men and women and greater for adolescents and persons with an STD diagnosed at enrollment. CONCLUSIONS: Short counseling interventions using personalized risk reduction plans can increase condom use and prevent new STDs. Effective counseling can be conducted even in busy public clinics.

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Background
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Background
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Background
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BackgroundInfluential
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“Thus, we assumed r = 0 and r = .99 as the most extreme values, and also imputed correlations from Project RESPECT (see Kamb et al., 1998), which provided moderate values of this association.”
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“Antiretroviral treatment of HIV-infected people was not selected as a prevention intervention to support because it costs $350,000 to prevent a single HIV infection through secondary prevention (more than the estimated lifetime cost of treatment of a newly infected person).(26) R e s o u r c e A l l o c a t i o n”
Background
HIV Prevention in Primary Care: Impact of a Clinical Intervention
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“Particularly critical is research on the impact of provider counseling on patient behavior; the study by Kamb et al. 35 is promising.”
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“This variable was less frequently studied, and the effects were seen in earlier studies, for example, Project RESPECT (Kamb et al., 1998).”
Result
Patient and Staff Perspectives on the Use of a Computer Counseling Tool for HIV and Sexually Transmitted Infection Risk Reduction
Mackenzie, S. L. C., Kurth, A., Spielberg, F., Severynen, A. O., Malotte, C. K., Lawrence, J. S. S., & Fortenberry, J. D. (2007) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2007.01.013 · Cited by 50
“Studies report that this is the result of several factors including clinician time constraints, competing demands, lack of training, and comfort level with sexual health discussions, as well as reduced health care budgets [4,11, 12 ].”
Background
Desired Elements of HIV Testing Services: Test Recipient Perspectives
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“In another study, from 1998, it was shown that short counselling interventions using personalized risk reduction plans can increase condom use and prevent new sexually transmitted diseases [20].”
Background
Promoting Regular Testing: An Examination of HIV and STI Testing Routines and Associated Socio-Demographic, Behavioral and Social-Cognitive Factors Among Men Who have Sex with Men in New South Wales, Australia
Adam, P. C. G., de Wit, J. B. F., Bourne, C., Knox, D., & Purchas, J. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0733-z · Cited by 50
“Sexual health screening remains a critical component of efforts to control epidemics of human immunodeficiency virus (HIV) and other sexually transmitted infections (STI), providing a necessary gateway to timely antiretroviral treatment and a unique platform for prevention [1–5],”
Background
STD/HIV Prevention Practices Among Primary Care Clinicians: Risk Assessment, Prevention Counseling, and Testing
Montaño, D. E., Phillips, W. R., Kasprzyk, D., & Greek, A. A. (2008) · Sexually Transmitted Diseases · doi:10.1097/olq.0b013e3181574d97 · Cited by 49
Behaviour change in clients of health centre-based voluntary HIV counselling and testing services in Kenya
Arthur, G., Nduba, V., Forsythe, S., Mutemi, R., Odhiambo, J. A., & Gilks, C. F. (2007) · Sexually Transmitted Infections · doi:10.1136/sti.2007.026732 · Cited by 49
‘What I've noticed what they need is the stats’: Lay HIV counsellors’ reports of working in a task-orientated health care system
Rohleder, P., & Swartz, L. M. (2004) · AIDS Care · doi:10.1080/09540120512331314376 · Cited by 51
“…0954-0121 print/ISSN 1360-0451 online # 2005 Taylor & Francis Group Ltd DOI: 10.1080/09540120512331314376 randomized controlled trial by Kamb et al. (1998) found short and enhanced counselling delivered by health department staff members who had received extra training to be an…”
BackgroundInfluential
Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992-1998
Sabin, K. M. (2001) · Journal of Heredity · doi:10.1093/jurban/78.2.241 · Cited by 49
Ethical issues in the NIMH Collaborative HIV/STD Prevention Trial
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Mosaic HIV-1 vaccine regimen in southern African women (Imbokodo/HVTN 705/HPX2008): a randomised, double-blind, placebo-controlled, phase 2b trial
Gray, G., Mngadi, K. T., Lavreys, L., Nijs, S., Gilbert, P. B., Hural, J., Hyrien, O., Juraska, M., Luedtke, A. R., Mann, P., et al. (2024) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(24)00358-x · Cited by 48
Interventions Delivered in Clinical Settings are Effective in Reducing Risk of HIV Transmission Among People Living with HIV: Results from the Health Resources and Services Administration (HRSA)’s Special Projects of National Significance Initiative
Myers, J. J., Shade, S. B., Rose, C. D., Koester, K. A., Maiorana, A., Malitz, F. E., Bie, J., Kang-Dufour, M.-S., & Morin, S. F. (2010) · AIDS and Behavior · doi:10.1007/s10461-010-9679-y · Cited by 48
Age at first intercourse and subsequent sexual partnering among adult women in the United States, a cross-sectional study
Magnusson, B. M., Nield, J., & Lapane, K. L. (2015) · BMC Public Health · doi:10.1186/s12889-015-1458-2 · Cited by 48
A Randomized Trial of a Behavioral Intervention for High Risk Substance-Using MSM
Kurtz, S. P., Stall, R. D., Buttram, M. E., Surratt, H. L., & Chen, M. (2013) · AIDS and Behavior · doi:10.1007/s10461-013-0531-z · Cited by 48
A Behavioral Intervention Reduces HIV Transmission Risk by Promoting Sustained Serosorting Practices Among HIV-Infected Men Who Have Sex With Men
Morin, S. F., Shade, S. B., Steward, W. T., Carrico, A. W., Remien, R. H., Rotheram‐Borus, M. J., Kelly, J. A., Charlebois, E. D., Johnson, M. O., & Chesney, M. A. (2008) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e31818d5def · Cited by 48
Chlamydia and gonorrhea screening in asymptomatic young women
Chacko, M. R., Wiemann, C. M., & Smith, P. B. (2004) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2004.03.041 · Cited by 48
“Moreover, extensive and personalized risk-reduction counseling interventions have been observed to reduce incident STIs by only 5 to 10%.(26,70,71,73) Thus, STI screening should be an important adjunct to risk-reduction efforts.”
Background
Computer Assisted Self Interviewing in a Sexual Health Clinic as Part of Routine Clinical Care; Impact on Service and Patient and Clinician Views
Vodstrcil, L. A., Hocking, J. S., Cummings, R., Chen, M. Y., Bradshaw, C. S., Read, T. R. H., Sze, J. K., & Fairley, C. K. (2011) · PLoS ONE · doi:10.1371/journal.pone.0018456 · Cited by 48
“Some of these concerns may be circumvented by further innovative developments with computer counseling but one could argue that the introduction of these developments should be carefully evaluated like all important health interventions before being introduced [16,17].”
Background
The cost-effectiveness of routine antenatal screening for maternal herpes simplex virus–1 and –2 antibodies
Thung, S., & Grobman, W. A. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.09.134 · Cited by 48
Persistence of Inconsistent Condom Use: Relation to Abuse History and HIV Serostatus
Hamburger, M. E., Moore, J., Koenig, L. J., Vlahov, D., Schoenbaum, E. E., Schuman, P. C., & Mayer, K. H. (2004) · AIDS and Behavior · doi:10.1023/b:aibe.0000044080.04397.97 · Cited by 48
“Several researchers have presented data that such enhanced counseling procedures lead to substantive increases in consistent condom use (Greenberg et al., 2000; Kamb et al., 1998; Wingood and DiClemente 1995, 1996; cf., Ickovics, 1994).”
Background
Risk reduction counselling for prevention of sexually transmitted infections: how it works and how to make it work
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Risk reduction counselling for prevention of sexually transmitted infections: how it works and how to make it work
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Risk Behaviors Related to Heterosexual Transmission From HIV-Infected Persons
Lansky, A., Nakashima, A. K., & Jones, J. L. (2000) · Sexually Transmitted Diseases · doi:10.1097/00007435-200009000-00012 · Cited by 48
Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: a pilot randomized controlled trial.
Coffin, P. O., Santos, G.-M., Matheson, T., Behar, E., Rowe, C., Rubin, T., Silvis, J., & Vittinghoff, E. (2017) · PLoS ONE · doi:10.1371/journal.pone.0183354 · Cited by 44
Randomized Clinical Trial of Brief Risk Reduction Counseling for Sexually Transmitted Infection Clinic Patients in Cape Town, South Africa
Kalichman, S. C., Cain, D., Eaton, L., Jooste, S., & Simbayi, L. C. (2011) · American Journal of Public Health · doi:10.2105/ajph.2011.300236 · Cited by 47
Factors Associated with HIV Testing: Results from an Italian General Population Survey
Renzi, C., Zantedeschi, E., Signorelli, C., & Osborn, J. F. (2001) · Preventive Medicine · doi:10.1006/pmed.2000.0778 · Cited by 47
Factors associated with delayed entry into primary HIV medical care after HIV diagnosis
Bamford, L. P., Ehrenkranz, P. D., Eberhart, M. G., Shpaner, M., & Brady, K. A. (2010) · AIDS · doi:10.1097/qad.0b013e328337b116 · Cited by 47
Efficacy of HIV/STI Behavioral Interventions for Heterosexual African American Men in the United States: A Meta-Analysis
Henny, K. D., Crepaz, N., Lyles, C. M., Marshall, K. J., Aupont, L. W., Jacobs, E. D., Liau, A., Rama, S. M., Kay, L. S., Willis, L. A., et al. (2012) · AIDS and Behavior · doi:10.1007/s10461-011-0100-2 · Cited by 47
Web 2.0 and beyond: risks for sexually transmitted infections and opportunities for prevention
RIETMEIJER, C. A. M., & McFarlane, M. (2008) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0b013e328320a871 · Cited by 46
Depression associated with sexually transmitted infection in Canada
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Structure of outcome beliefs in condom use.
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Impact of Counseling in Voluntary Counseling and Testing Programs for Persons at Risk for or Living with HIV Infection
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Bathhouse-Based Voluntary Counseling and Testing Is Feasible and Shows Preliminary Evidence of Effectiveness
Huebner, D. M., Binson, D., Woods, W. J., Dilworth, S. E., Neilands, T. B., & Grinstead, O. A. (2006) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/01.qai.0000242464.50947.16 · Cited by 45
“These findings are consistent with those of studies from other nontraditional VCT settings that suggest VCToffered outside clinic settings can reach high-risk individuals, many of whom are at greater risk than those who access HIV testing in clinics.24,25 Our preliminary effectiveness data are also consistent with som…”
BackgroundResultInfluential
Behavioural interventions to prevent HIV infection: rapid evolution, increasing rigour, moderate success
Bonell, C. P., & Imrie, J. C. (2001) · British Medical Bulletin · doi:10.1093/bmb/58.1.155 · Cited by 45
High Rates of Depressive Symptoms in STD Clinic Patients
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A public health dilemma: A testing question
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Background
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The cost-effectiveness of symptom-based testing and routine screening for acute HIV infection in men who have sex with men in the USA
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Acceptance of HIV Antibody Testing Among Inpatients and Outpatients at a Public Health Hospital: A Study of Rapid versus Standard Testing
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Achieving Safer Sex with Choice: Studying a Women's Sexual Risk Reduction Hierarchy in an STD Clinic
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“These attrition rates were in line with those re-ported by other large intervention studies 66,67 and are not surprising, given the mobility of these populations and their relatively sporadic health-care visit schedules.”

Authors: Kamb, M. L., Fishbein, M., Douglas, Jr., Rhodes, F., Rogers, J., Bolan, G., Zenilman, J., Hoxworth, T., Malotte, C. K., Iatesta, M., Kent, C., Lentz, A., Graziano, S., Byers, R. H., Peterman, T. A., & for the Project RESPECT Study Group
Affiliations: Centers for Disease Control and Prevention (US)
ORCID: Kamb, Mary L.
Bolan, Gail
Hoxworth, Tamara
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 1998-10-07
Volume: 280
Issue: 13
Pages: 1161
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.280.13.1161
OpenAlex: W2153335467
Cited by: 973
References: 22
Citations by year: 2026: 5 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 14 · 2021: 11 · 2020: 11 · 2019: 17 · 2018: 21 · 2017: 18 · 2016: 32 · 2015: 26 · 2014: 57 · 2013: 35 · 2012: 49
FWCI: 29.60
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Adolescent Sexual and Reproductive Health
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords: HIV prevention, sexually transmitted infections, risk reduction counseling, condom use, STD incidence, gonorrhea, chlamydia, syphilis, HIV, STD clinics, adolescents, HIV-negative patients, sexual behavior change
MeSH terms: Adolescent, Adult, Community Health Services, Counseling, Female, Humans, Male, Risk Factors, Sexually Transmitted Diseases, United States, HIV Infections

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Efficacy of Risk-Reduction Counseling to Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases: A Randomized Controlled Trial

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