Background: National HIV/AIDS Strategy implementation has prompted agencies to evaluate their current HIV prevention services and favor those with the most potential for impact. This means placing more attention on HIV testing, linkage to medical care, and prevention for people with HIV; and less attention on multi-session and group-level behavioral interventions.
Methods: We received funding from the Centers for Disease Control and Prevention in 2010 to implement RESPECT, an HIV and STD risk-reduction intervention with evidence of effectiveness when delivered using either a 2-session or 1-session model, among MSM at a community-based site. RESPECT was paired with rapid HIV testing. In 2012 we moved from a 2-session intervention model to a single-session model.
Results: Implementing a 2-session risk-reduction intervention in the context of HIV rapid testing was challenging. RESPECT relied on the counselor using a “teachable moment” to increase the client’s perceived HIV and STD risk and encourage behavior change. The teachable moment usually occurred at delivery of the HIV test result in the first session, but once clients received their results they were unlikely to return for session 2. Counselors had trouble persuading clients to return, which led to weak retention rates. Counselors began losing faith in the intervention and offering it to clients less frequently. Additionally, those clients who were offered RESPECT often opted out because of the added commitment of a second session. Adopting a 1-session model produced several effects: counselors offered the intervention more frequently, more clients were willing to participate, and the intervention was completely embedded into our HIV testing program.
Conclusions: Moving to a 1-session model improved our ability to embed the risk-reduction intervention into HIV testing. Ultimately more clients participated in the intervention, thereby developing and implementing HIV and STD risk reduction plans.