WP 83 Implementation of Project Respect in a Busy Primary and HIV Specialty Care Clinic

Tuesday, June 10, 2014
International Ballroom
Emanuel Vergis, Associate Professor of Medicine, Department of Medicine, Division of Infectious Disease, University of Pittsburgh, Pittsburgh, PA

Background: The University of Pittsburgh HIV/AIDS program provides care to over 1,500 HIV-infected persons.  MSM and MSM who use injection drugs (MSM-IDU) represent 58% of the clinic population.  Since 2010, there has been a steady increase in new syphilis diagnoses from 1.5% to 4% with the majority of cases representing re-infection.  The CDC RESPECT protocol was adapted for implementation with HIV-positive MSM to reduce high-risk sexual behaviors through client-centered discussions.

Methods: This is a longitudinal descriptive research project intended to inform on: (1) the feasibility of implementing RESPECT using a peer counselor; (2) the compendium of client-identified risk reduction strategies, and; (3) the effectiveness of risk reduction strategies.

Results: Between 9/29/2010 through 7/9/2012, 161 non-duplicated clients were referred to RESPECT.  Unsafe oral sex was the predominant sexual risk category (73.1%) followed by unsafe sex involving friends with benefits, group sex, or sex with a non-primary sexual partner.  Approximately 11% of clients reported unprotected anal sex.  Ninety-four (58.4%) clients participated in at least two RESPECT sessions.  Nearly 39% of clients agreed to try the female condom for anal sex, 19.2% agreed to maintain their current level of safer behaviors and 11.4% expressed interest in other strategies.  Approximately 63% of clients achieved their risk reduction goals, but in nearly 15%, progress toward risk reduction could not be determined.

Conclusions: The findings suggest that it is feasible to implement RESPECT in the HIV primary care clinical setting.  Challenges encountered included limited availability of the counselor, lack of buy-in by other providers, follow-up sessions coinciding with regularly scheduled clinic visits where other issues may take precedence and adapting RESPECT for HIV-infected MSM in the context of the continuum of sexual risk taking behaviors.  The changing nature of sexual risk-taking behaviors reported by clients over the course of their involvement suggests the need to identify mediators of risk behaviors.