Past Research Studies and Publications
AHP has participated in many studies in the past. Among the most significant of these are the Promoting Safer Sex Study, the Changing Sexual Behavior Study, and the HIV Oral Transmission (HOT) Study, all three of which are collaboration among researchers from AHP, the UCSF Center for AIDS Prevention Studies (CAPS), and the San Francisco Department of Public Health.
The Red Studies
HIV antibody counseling and testing has been a cornerstone of HIV prevention activities since early in the epidemic. Data from AHP’s own counseling and testing sites in San Francisco—we test more than 5,000 people a year—have shown that many men who have sex with men return to test again and again, reporting during counseling that their sexual activity had continued to put them at risk for acquiring HIV.
We observed that risk reduction counseling was not working for these men, specifically those who tested three or more times. At the same time, Australian researcher Ron Gold had undertaken a series of studies which looked at the thoughts and feelings gay men experienced that enabled them to engage in sexual activities that they knew put them at risk for HIV.
In response to these two insights, AHP developed an intervention and a series of studies—The Red Studies—to test the intervention. At the core of the intervention is Gold’s idea that by looking at the rationalizations gay men use to justify behaviors in which they, in fact, do not want to engage, these men can better carry out their own desires to protect themselves. We have since tested this intervention under numerous conditions.
Promoting Safer Sex Practices among High-Risk Repeat HIV Testers in San Francisco: 1997-2000
Investigators: James W. Dilley, MD; William Woods, PhD; and Willi McFarland, MD, PhD
The Promoting Safer Sex Study was the first trial. This four-year study asked HIV-negative participants to explore the thoughts and feelings they held during a recent instance of unprotected anal sex with an HIV-positive partner or a partner of unknown HIV status. Licensed mental health providers then helped participants explore their thoughts and feelings in relation to their sexual behavior.
The study followed 248 participants for one year after the initial counseling session. The sample was randomly divided into four groups of participants based on the intervention they received:
• Cognitive-behavioral intervention added to standard HIV test counseling
• Cognitive-behavioral intervention and the assignment to keep a sexual diary added to standard HIV test counseling
• Standard HIV test counseling only
• Standard HIV test counseling and the assignment to keep a sexual diary
We conducted follow-up evaluations six months and twelve months after the test counseling session. We asked participants in the two groups that kept the sexual diary to write about their sexual behavior in the 90 days following the initial test counseling session.
Three of the tested prevention strategies significantly decreased the frequency of unprotected anal sex, when added to standard client-centered HIV counseling and testing: the 90-day sexual diary, the cognitive-behavioral counseling session focusing on thoughts and feelings before unprotected anal intercourse, or the combination of both. Further, the prevention effects of these three interventions persisted through to the 12-month follow-up. In contrast, standard counseling alone appeared to have, at best, only a small, short-term prevention effect.
This cognitive-behavioral counseling strategy has strong, practical appeal. First, it can be implemented in one session. Second, the magnitude of the prevention effect—roughly decreasing unprotected anal sex with partners of unknown or discordant HIV status by three episodes in a 90-day period—may produce substantial decreases in personal risk for HIV acquisition.
The results of this study have been published in several journal articles. The most comprehensive article is: Dilley JW, Woods WJ, Sabatino J, Lihatsh T, Adler B, Casey S, Rinaldi J, Brand R, McFarland W. Changing sexual behavior among gay male repeat testers for HIV: A randomized, controlled trial of a single-session intervention. Journal of Acquired Immune Deficiency Syndromes. 2002; 30(2): 177-186.
More Past Studies and Publications
