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

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.