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One-on-One Counseling Stems Spread of AIDS

Unprotected sex declined among HIV-positive young adults who got it

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HealthDay Reporter

FRIDAY, Oct. 8, 2004 (HealthDayNews) -- Convincing HIV-positive young adults to avoid infecting others is one of the biggest challenges in the fight against AIDS.

But in a new study, American researchers contend the solution may lie in one-on-one counseling that encourages people to make better decisions by understanding their own personal values.

The rates of one kind of unprotected sex dropped by more than 30 percent among HIV-positive drug users who underwent an intensive counseling program. "You shore up a person's ability to control their life and change their behavior," said Lee Klosinski, director of programs at AIDS Project Los Angeles, which hopes to replicate the study's findings. The counseling "equips them to make healthy choices in their life."

An estimated 110,000 Americans under the age of 23 are infected with the AIDS virus. Studies suggest that many of them aren't aware they're sick; those who know they're infected don't always take the expensive drugs that have revolutionized the treatment of AIDS over the past eight years.

Researchers offered a choice of three infection-prevention programs to 175 HIV-positive young people in Los Angeles, San Francisco, and New York City. The subjects, aged 16 to 29, were regular users of methamphetamine or intravenous drugs; more than two-thirds were gay men.

The participants, for the most part, had been very sexually active before the study: They reported a median of 50 sexual partners over their lifetime, and 21 said they'd had sex with 1,000 or more people. The risk is that they will continue to have unprotected sex and infect others.

Some of the subjects had as many as 18 sessions with a counselor over the phone. Another group attended one-on-one sessions, while a third group was assigned to get counseling at a later date. All participants received $20 to $25 for attending each of four meetings with counselors to measure their progress.

The goal of the counseling was to bring out an inner sense of responsibility in the participants, said study co-author Mary Jane Rotheram, director of the Center for Community Health at the University of California at Los Angeles. "Most people want to be good people," she said. "Our program helps people remember what's joyful and happy in their lives, and helps them figure out how to maintain that on a daily basis."

The findings appear in the October issue of the Journal of Acquired Immune Disorders.

The study suggested the one-on-one counseling convinced more than a third of participants to cut down on unprotected sex with partners whose HIV status -- positive or negative -- was unknown. "They had the same amount of sex, but it was either protected or they went to HIV-positive people," Rotheram said.

The telephone counseling wasn't as successful.

The findings are encouraging because they show that the federal emphasis on counseling is a good idea, said Steve Morin, director of the AIDS Policy Research Center at the University of California at San Francisco. "What this study illustrates is that it works."

Previous research has suggested that the counseling approach works in groups. But counseling several young people at once isn't feasible in many parts of the country, such as rural areas, Rotheram said. "This showed that you could also work with kids individually."

The next step is to expand the counseling program, Rotheram said. "We're being funded by the CDC [U.S. Centers for Disease Control and Prevention] to train providers so we can make this a routine part of medical care."

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SOURCES: Mary Jane Rotheram, Ph.D., director, Center for Community Health, University of California at Los Angeles; Lee Klosinski, Ph.D., director, programs, AIDS Project Los Angeles; Steve Morin, Ph.D., director, AIDS Policy Research Center, University of California at San Francisco; October 2004 Journal of Acquired Immune Disorders

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