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
Serosorting for hepatitis C status in the sharing of injection equipment among Seattle area injection drug users
Burt, R. D., Thiede, H., & Hagan, H. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.07.005 · Cited by 32
“There is convincing evidence that knowledge of HIV positive status is associated with practices which reduce HIV transmission risk (Des Jarlais et al., 2004; Kamb et al., 1998; Marks et al., 2005; Weinhardt et al., 1999).”
Background
‘Before we were sleeping, now we are awake’: Preliminary evaluation of theStepping Stonessexual health programme in The Gambia
Paine, K., Hart, G. J., Jawo, M., Ceesay, S., Jallow, M., Morison, L. A., Walraven, G. E. L., McAdam, K. P. W. J., & Shaw, M. (2002) · African Journal of AIDS Research · doi:10.2989/16085906.2002.9626543 · Cited by 32
Beyond the most willing audiences: A meta-intervention to increase exposure to HIV-prevention programs by vulnerable populations.
Albarracín, D., Durantini, M. R., Earl, A. N., Gunnoe, J. B., & Leeper, J. (2008) · Health Psychology · doi:10.1037/0278-6133.27.5.638 · Cited by 32
“The counseling session was adapted from Project Respect (see Kamb et al., 1998), and focused on condom use behavioral skills, condom use negotiation skills, and self-management skills—skills to promote perceived behavioral control over condom use despite unfavorable mood or circumstances (Kelly,…”
Self-reported syphilis and gonorrhoea testing among men who have sex with men: national HIV behavioural surveillance system, 2003-5
Tai, E. W., Sanchez, T., Lansky, A., Mahle, K. C., Heffelfinger, J. D., & Workowski, K. (2008) · Sexually Transmitted Infections · doi:10.1136/sti.2008.030973 · Cited by 31
Case–Crossover Study of Partner and Situational Factors for Unprotected Sex
Seage, G. R., Holte, S., Gross, M., Koblin, B. A., Marmor, M. F., Mayer, K. H., & Lenderking, W. R. (2002) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/00126334-200212010-00010 · Cited by 32
“Interventions for women at risk for HIV infection that focus on individualized interpersonal approaches have shown some success ( 41 ,42), whereas interventions that have involved male partners have not been successful at reducing women’s risk (43,44).”
Background
Comparison of Missed Opportunities for Earlier HIV Diagnosis in 3 Geographically Proximate Emergency Departments
Lyons, M. S., Lindsell, C. J., Wayne, D. B., Ruffner, A. H., Hart, K. W., Fichtenbaum, C. J., Trott, A. T., & Sullivan, P. S. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2011.03.018 · Cited by 32
Routine opt-out HIV testing
Lifson, A. R., & Rybicki, S. L. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60249-9 · Cited by 32
Reducing Risk of Sexually Transmitted Disease (STD) and Human Immunodeficiency Virus Infection in a Military STD Clinic: Evaluation of a Randomized Preventive Intervention Trial
Jenkins, P. R., Jenkins, R. A., Nannis, E. D., McKee, K. T., & Temoshok, L. R. (2000) · Clinical Infectious Diseases · doi:10.1086/313743 · Cited by 32
“The CDC-sponsored project RESPECT [4] and the National Institute of Mental Health’s Multisite HIV Prevention Trial [5] provide models of successful, multiple-session interventions in STD clinic settings that would be compatible with the behavior-change principles used in the present investigation.”
Method
A Randomized Controlled Trial to Evaluate the Relative Efficacy of Enhanced Versus Standard Voluntary Counseling and Testing on Promoting Condom Use among Men Who Have Sex with Men in China
Hao, C., Huan, X., Yan, H., Yang, H., Guan, W., Xu, X., Zhang, M., Wang, N., Tang, W., Gu, J., et al. (2012) · AIDS and Behavior · doi:10.1007/s10461-012-0141-1 · Cited by 32
Development of programmes for enhancing sexual health
DiClemente, R. J. (2001) · The Lancet · doi:10.1016/s0140-6736(01)06878-7 · Cited by 32
Evidence and the Politics of Deimplementation: The Rise and Decline of the “Counseling and Testing” Paradigm for HIV Prevention at the US Centers for Disease Control and Prevention
Johns, D. M., Bayer, R., & Fairchild, A. L. (2016) · Milbank Quarterly · doi:10.1111/1468-0009.12183 · Cited by 32
Reassessing Adolescent Male Sexual and Reproductive Health in the United States: Research and Recommendations
Lindberg, L., Sonfield, A., & Gemmill, A. (2007) · American Journal of Men s Health · doi:10.1177/1557988307309460 · Cited by 30
Randomized Trial of Brief Office-Based Interventions to Reduce Adolescent Alcohol Use
Boekeloo, B. O., Jerry, J., Lee-Ougo, W. I., Worrell, K. D., Hamburger, E. K., Russek‐Cohen, E., & Snyder, M. H. (2004) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.158.7.635 · Cited by 31
Substance Use Disorders and HIV/AIDS Prevention and Treatment Intervention: Research and Practice Considerations
Campbell, A. N. C., Tross, S., & Calsyn, D. A. (2013) · Social Work in Public Health · doi:10.1080/19371918.2013.774665 · Cited by 31
“…settings can further contribute to the prevention of HIV/STI by (a) becoming competent in delivering brief prevention interventions (e.g., RESPECT; Kamb et al., 1998; and RESPECT2; Metcalf et al., 2005); (b) becoming familiar with brief video HIV prevention interventions (e.g., Safe in the City;…”
BackgroundMethod
HIV Diagnosis and Risk Behavior
Weinhardt, L. S. (2005) · Kluwer Academic Publishers-Plenum Publishers eBooks · doi:10.1007/0-306-48700-4_2 · Cited by 31
CCAR: An efficient method for mining class association rules with itemset constraints
Nguyen, D., Vo, B., & Le, B. H. (2014) · Engineering Applications of Artificial Intelligence · doi:10.1016/j.engappai.2014.08.013 · Cited by 30
Pre-Exposure Prophylaxis for HIV
Curran, J. W., & Crosby, R. A. (2012) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.10.005 · Cited by 30
Individual interventions
Mimiaga, M. J., Reisner, S. L., Reilly, L. C., Soroudi, N., & Safren, S. A. (2009) · Elsevier eBooks · doi:10.1016/b978-0-12-374235-3.00008-x · Cited by 30
Evaluation of a pregnancy prevention programme using the Contraceptive Behavior Change model
Chung-Park, M. (2007) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2007.04468.x · Cited by 30
HIV incidence and risk behaviours after voluntary HIV counselling and testing (VCT) among adults aged 19–35 years living in peri-urban communities around Chiang Mai city in northern Thailand, 1999
Kawichai, S., Beyrer, C., Khamboonruang, C., Celentano, D. D., Natpratan, C., Rungruengthanakit, K., & Nelson, K. E. (2004) · AIDS Care · doi:10.1080/09540120310001633949 · Cited by 30
“The other large trial, reported by Kamb et al. (1998), was carried out in 5,758 HIV-negative clients of public STD clinics in five cities in the US.”
Background
Condom use behaviours among 18–24 year-old urban African American males: a qualitative study
Kennedy, S. B., Nolen, S., Applewhite, J., Waiters, E. D., & Vanderhoff, J. (2007) · AIDS Care · doi:10.1080/09540120701235610 · Cited by 30
Approaching "HIV elimination": Interventions for acute HIV infection
Pilcher, C. D., Eaton, L. A., Kalichman, S. C., Bisol, C. A., & de Souza, R. D. S. (2006) · Current HIV/AIDS Reports · doi:10.1007/s11904-006-0011-4 · Cited by 30
Maintenance and Decay of Past Behavior Influences: Anchoring Attitudes on Beliefs Following Inconsistent Actions
Albarracín, D., & McNatt, P. S. (2005) · Personality and Social Psychology Bulletin · doi:10.1177/0146167204272180 · Cited by 30
“We analyzed the data collected by Project RESPECT, a multisite study funded by CDC. Project RESPECT (Kamb et al., 1998; Kamb, Dillon, Fishbein, Willis, & Project RESPECT Study Group, 1996) was a randomized controlled trial comparing three separate face-to-face HIV/STD prevention interventions with follow-ups over a ye…”
BackgroundMethodInfluential
'You can't tell by looking': pilot study of a community-based intervention to detect asymptomatic sexually transmitted infections
Low, N. N., Connell, P., McKevitt, C., Baggili, T., Tenant‐Flowers, M., More, C., Zuckerman, M. A., Hamilton, M., Jones, J., Blake, M. K., et al. (2003) · International Journal of STD & AIDS · doi:10.1258/095646203322556174 · Cited by 29
Evaluating a Brief, Video-Based Sexual Risk Reduction Intervention and Assessment Reactivity with STI Clinic Patients: Results from a Randomized Controlled Trial
Carey, M. P., Senn, T. E., Walsh, J. L., Coury-Doniger, P. A., Urban, M. A., Fortune, T., Vanable, P. A., & Carey, K. B. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0960-3 · Cited by 30
Hepatitis C prevention and treatment for substance users in the United States: acknowledging the elephant in the living room
Edlin, B. R. (2004) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2003.10.007 · Cited by 29
Self-monitoring of behaviour as a risk reduction strategy for persons living with HIV
Lightfoot, M. A., Rotheram–Borus, M. J., Comulada, S., Gundersen, G., & Reddy, V. (2007) · AIDS Care · doi:10.1080/09540120600971117 · Cited by 29
“…et al., 1991), youth living with HIV (Rotheram-Borus et al. , 2001), patients at sexually transmitted disease clinics (O’Leary et al. , 1998), the AIDS Community Demonstration Projects (CDC, 1996), Project Respect (Kamb et al. , 1998), and among women (Ehrhardt et al. , 2002; Hobfoll et al., 1994).”
Background
Efficacy of SISTA South Africa on Sexual Behavior and Relationship Control Among isiXhosa Women in South Africa
Wingood, G. M., Reddy, P. S., Lang, D. L., Onoya, D., Braxton, N. D., Sifunda, S., & DiClemente, R. J. (2013) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e31829202c4 · Cited by 29
Lowering obstacles to HIV prevention services: Effects of a brief, telephone-based intervention using motivational enhancement therapy
Picciano, J. F., Roffman, R. A., Kalichman, S. C., & Walker, D. D. (2007) · Annals of Behavioral Medicine · doi:10.1007/bf02872672 · Cited by 29
“The Center for Disease Control and Prevention’s Project RESPECT, for example, showed that two 20-min HIV risk reduction counseling sessions conducted in conjunction with HIV antibody testing demonstrated the same efficacy in reducing HIV risk behavior and recurrent sexually transmitted infections (STI) as did a four-s…”
Initiating contraception in sexually transmitted disease clinic setting: a randomized trial
Shlay, J. C., Mayhugh, B., Foster, M., Maravi, M. E., Barón, A. E., & Douglas, J. M. (2003) · American Journal of Obstetrics and Gynecology · doi:10.1067/s0002-9378(03)00493-9 · Cited by 29
Acting on one's intentions: Variations in condom use intentions and behaviours as a function of type of partner, gender, ethnicity and risk
von Haeften, I., Fishbein, M., Kaspryzk, D., & Montaño, D. E. (2000) · Psychology Health & Medicine · doi:10.1080/713690182 · Cited by 29
“That is, consistent with previous research (e.g. Kamb et al., 1998; CDC, 1999; Schnell et al., 1996), we expect people to be more likely to form intentions to always use condoms with casual than with main partners and, among commercial sex workers (CSWs), we expect stronger intentions to always use…”
BackgroundResult
Sexually Transmitted Infections
Fisman, D. N. (2004) · doi:10.1002/9780470988336.ch10 · Cited by 29
HIV Voluntary Counseling and Testing and HIV Incidence in Male Injecting Drug Users in Northern Thailand
Kawichai, S., Celentano, D. D., Vongchak, T., Beyrer, C., Suriyanon, V., Razak, M. H., Srirak, N., Rungruengthanakit, K., & Jittiwutikarn, J. (2006) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/01.qai.0000179431.42284.3e · Cited by 28
Brief sexuality communication—a behavioural intervention to advance sexually transmitted infection/ HIV prevention: a systematic review
Cooper, B., Toskin, I., Kulier, R., Allen, T., & Hawkes, S. (2014) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12877 · Cited by 28
Is There Life After DEBI? Examining Health Behavior Maintenance in the Diffusion of Effective Behavioral Interventions Initiative
Feldman, M. B., Silapaswan, A., Schaefer, N., & Schermele, D. (2014) · American Journal of Community Psychology · doi:10.1007/s10464-014-9629-3 · Cited by 28
Fewer partners or more condoms? Modelling the effectiveness of STI prevention interventions
Garnett, G. P., White, P. J., & Ward, H. (2008) · Sexually Transmitted Infections · doi:10.1136/sti.2008.029850 · Cited by 28

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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