Background:  In 2003, the Centers for Disease Control and Prevention (CDC) published guidelines for conducting behavioral interventions in HIV care settings. Following these recommendations, we evaluated a risk-reduction intervention delivered by medical providers at 7 sites to test the feasibility of wide-scale implementation.

Methods:  Medical providers at 7 HIV clinics in New York, North Carolina, Georgia, Tennessee, Missouri, and Colorado delivered a standardized safer sex and drug-use intervention that screened patients for behavioral risks, gave targeted counseling, and delivered prevention messages at all routine patient visits. The intervention was evaluated with a longitudinal cohort of 767 patients who received the intervention (no control group), completed a baseline questionnaire and 2 follow-up questionnaires at 6 and 12 months. Logistic regression with GEE methods was used in statistical analyses.

Results:  The 3-month prevalence of unprotected anal or vaginal intercourse with any partners declined significantly (p <0.001) from baseline (42%) to follow-up at 6 months (26%) and 12 months (23%). The decline was significant with all serostatus partners, whether HIV^–/unknown serostatus or HIV⁺. The percentage reductions in unprotected anal or vaginal intercourse between baseline and 6 months showed a dose-response relationship with patient self-reports of receiving safer-sex counseling:  45% if counseling at all clinic visits, 35% if counseling at some clinic visits, and 19% if counseling at no clinic visits. These findings were confirmed in multivariate models that controlled for demographic factors and HIV clinical status of participants.

Conclusions:  Despite receiving only brief training, HIV medical providers in 6 states successfully conducted an HIV prevention intervention with their clinic patients. We observed significant declines in unprotected anal or vaginal intercourse among men who have sex with men (MSM), heterosexual men, and heterosexual women. Our findings constitute a test of the feasibility of wide-scale implementation of the type of safer sex and drug-use intervention that was conducted in 2 U.S. behavioral intervention trials (Options project in Connecticut, and Partnership for Health in California). HIV care clinics are an efficient context for delivery of prevention messages because of the repeated routine contacts between patients and their care provider. Clinics that serve HIV patients should incorporate such programs as standard of care in treating those patients.