This paper presents lessons learned from an intervention designed to provide HIV prevention counseling within a hospital-based, multidisciplinary HIV clinic. The model, Positive Prevention, used Master's-level social workers (MSWs) as intervention specialists to minimize burden on primary care providers and to offer a replicable way to provide prevention in a similar setting. The intervention goal was to reduce risk behaviors through Motivational Interviewing, a patient-centered counseling approach with proven success impacting behavioral change. Implementation experiences offer insight into the challenges of using MSWs as prevention specialists. Particular challenges were related to patient engagement and retention. Experiences early in the implementation process were informative and allowed for adaptations to facilitate a more viable program; however even after executing new strategies, many of the program issues remained. Thus, the Positive Prevention model is not recommended as a best HIV prevention model for replication in similar high-volume, hospital-based, multidisciplinary HIV clinic settings.
"Social cognitive theory (Bandura, 1986, 1994) Golin et al. (2007) Kalichman et al. (2005) Kalichman et al. (2007) Patterson et al. (2003) Wingood et al. (2004) Wolitski et al. (2005) Transtheoretical/stages of change model (Prochaska & DiClemente, 1982) Callahan et al. (2007) Grimley et al. (2007) Holstad et al. (2006) Nollen et al. (2007) Rutledge (2007) Zuniga et al. (2007) Information-motivation-behavioral skills Model (Fisher & Fisher, 1992) Fisher et al. (2006) Margolin et al. (2003) Wolitski et al. (2005) Harm reduction theory (Spring, 1991) Callahan et al. (2007) Zuniga et al. (2007) Theory of gender and power (Wingood & DiClemente, 2002) Wingood et al. (2004) Theory of planned behavior (Ajzen, 1985) Wolitski et al. (2005) Theory of reasoned action (Ajzen & Fishbein, 1975) Golin et al. (2007) Behavioral self-efficacy (Bandura, 1977) Zuniga et al. (2007) Social action theory (Ewart, 1991) Healthy Living Project Team (2007) Counseling Methods Motivational interviewing (Miller & Rollnick, 2002) Callahan et al. (2007) Fisher et al. (2006) Golin et al. (2007) Holstad et al. (2006) Nollen et al. (2007) Rutledge (2007) Cognitive-behavioral therapies (Dobson, 2003) Healthy Living Project Team (2007) Margolin et al. (2003) Wolitski et al. (2005) Message framing (Rothman & Salovey, 1997) compared HIV transmission prevention assessment and counseling by physicians treating HIV-infected patients by interviewing 44 physicians in the San Francisco Bay area during 1995 through 1997. The authors identified two extremes of physician communication styles that they labeled as consultants or collaborators. "
[Show abstract][Hide abstract] ABSTRACT: HIV prevention education and counseling efforts have historically been directed toward those individuals considered at risk for exposure to HIV and assumed to be uninfected with HIV. In the late 1990s, prevention efforts began to include individuals who were HIV-infected. In 2003, the Centers for Disease Control and Prevention recommended that HIV prevention be incorporated into the medical care of persons living with HIV. This domain of HIV prevention work is known as prevention with positives or positive prevention, and research within this domain has been ongoing for a decade. This article provides a review of the scientific evidence within the prevention with positives domain from 1998 to 2008. A discussion is provided regarding early descriptive and formative studies as well as more recent and ongoing intervention trials specifically designed for persons living with HIV. A summary of current knowledge, a description of ongoing research, and gaps in knowledge are identified. Topics for future research are suggested.
The Journal of the Association of Nurses in AIDS Care: JANAC 03/2009; 20(2):92-109. DOI:10.1016/j.jana.2008.11.001 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Screening and brief intervention (SBI) for alcohol reduction is an important health promoting strategy for patients with HIV, and HIV care providers are optimally situated to support their patients' reduction efforts. We report results from analyses that use data collected from providers (n = 115) in 7 hospital-based HIV care centers in the New York City metropolitan area in 2007 concerning their routine use of 11 alcohol SBI components with their patients. Providers routinely implemented 5 or more of these alcohol SBI components if they (1) had a specific caseload (and were therefore responsible for a smaller number of patients), (2) had greater exposure to information about alcohol's effect on HIV, (3) had been in their present positions for at least 1 year, and (4) had greater self efficacy to support patients' alcohol reduction efforts. Findings suggest the importance of educating all HIV care providers about both the negative impact of excessive alcohol use on patients with HIV and the importance and value of alcohol SBIs. Findings also suggest the value of promoting increased self efficacy for at least some providers in implementing alcohol SBI components, especially through targeted alcohol SBI training.
AIDS patient care and STDs 03/2009; 23(3):211-8. DOI:10.1089/apc.2008.0008 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The absence of adequate and regular prevention counseling during routine clinical encounters translates into missed opportunities for HIV prevention. HIV care providers have considerably more contact with patients than clinicians in other disciplines. These contacts should be translated into opportunities to provide HIV prevention messages to patients and should be a priority for all clinicians caring for HIV-positive patients. Coincidental preventive care for HIV-positive patients is inherently unproductive because of the absence of reinforcing messages. In a recent meta-analysis, HIV-positive individuals who underwent counseling and testing services reduced high-risk behaviors by about 68%. Prevention counseling should focus on positive reinforcement, harm reduction, education, and support. We strongly recommend regular, brief, targeted prevention counseling as a part of every clinical encounter.
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