Positive Choice: Prevention for Positive Health

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DESCRIPTION (provided by applicant): Substance abuse and sexual risky behaviors can greatly compromise the health of people with HIV/AIDS and their sexual partners. To support HIV-infected individuals in changing these risk behaviors, innovative preventive interventions must be developed and implemented in health care settings in a way that maximizes the role of health care providers without increasing their burden. These interventions must consistently assess for individuals' risks and intervene using the latest strategies for behavior change. Computer programs using multimedia technology hold great promise for assessing patient risk; delivering brief motivational interventions to at-risk, under-treated populations; and activating providers to give prevention messages. We propose to develop Positive Choice, an intervention involving a multimedia program, provider and patient education, and provider cueing. The multimedia program features a video doctor who assesses patients' substance use and sexual risks and delivers a brief motivational risk-reduction intervention tailored to patients' readiness to change and risk profile. The brief motivational intervention includes personalized feedback, tailored advice messages, prompt sheets, peer modeling, and printed and multimedia information. The provider cueing sheet will summarize each patient's risks and suggest targeted risk-reduction messages to reinforce behavior change. The Positive Choice intervention can be seamlessly integrated into primary care for HIV-infected individuals. HIV-positive patients at two public hospital-based HIV-outpatient clinics who report substance abuse (alcohol and/or drug abuse) and/or unprotected sex will be enrolled in a randomized controlled trial. Patients in the intervention group will receive the brief motivational intervention and their providers will receive a cueing sheet at baseline and again at 6 months. We will determine whether the Positive Choice intervention increases rates of patient-provider discussions about risks, increases patients' acceptance of referral to substance abuse counseling, and reduces sexual risk behaviors at 6- and 12-month follow-up. If proven effective, Positive Choice could be implemented into other health care settings to improve the health of HIV-positive people and decrease the transmission of HIV.