RESPECT: An Effective, Individual, Client-focused HIV Prevention Counseling Intervention
RESPECT
is the first individual level intervention to be added to the Diffusion
of Effective Behavioral Interventions (DEBI). The RESPECT intervention
utilizes a client-focused, interactive HIV risk reduction counseling
model based on Project RESPECT. This study was a randomized controlled
trial, implemented in 5 cities, to assess the efficacy of HIV
prevention counseling in reducing high risk sexual behaviors and
preventing new STDs. The study evaluated a 2-session and 4-session
counseling interventions utilizing the RESPECT protocol, and found that
risk taking behaviors were reduced in both counseling models. Delivery
of brief didactic prevention messages were also evaluated, but did not
result in significant behavior changes.
The RESPECT intervention is
designed to support risk reduction behaviors by increasing the client’s
perception of his/her personal risks and by emphasizing incremental
risk-reduction strategies. Core elements of the intervention are to
conduct one-on-one counseling using the RESPECT protocol, utilize a
“teachable moment” to motivate clients to change risk-taking behaviors,
explore circumstances and context of a recent risk behavior to increase
perception of susceptibility, negotiate an achievable step which
supports the larger risk reduction goal, and implement and maintain
quality assurance procedures. The intervention uses a structured
protocol that guides the provider/counselor throughout the sessions.
This protocol also helps address barriers to risk reduction and
validate previous attempts made by the client.
Because RESPECT
was originally studied in an STD clinic utilizing HIV testing,
counseling and referral, readers may have questions related to the
similarities and differences between the two. Please refer to the Frequently Asked Questions (FAQ) document on the RESPECT website for more information.
RESPECT
is an interactive counseling model that can be easily incorporated into
many existing programs, such as comprehensive risk counseling services
(CRCS), early intervention programs, rapid or traditional HIV
counseling and testing programs, and STD, HIV, or family planning
clinics, where discussion of client risk and risk reduction strategies
occur. Examples of the settings where RESPECT can be implemented are
discussed in the “How RESPECT can be Integrated into other HIV Prevention Programs” document.
By adopting this model, organizations can substantially increase the
effectiveness of their individual-level interventions in their HIV
programs. Both the 2-session brief counseling and 4-session enhanced
counseling resulted in reduced risk taking behaviors and reductions in
new STD infections. This is good news for busy clinic settings where
brief counseling may be the only feasible approach.
Research and Development
Kamb,
M.L., Fishbein, M., Douglas , J.M., Rhodes , F., Rogers , J., Bolan,
G., Zenilman, J., Hoxworth, T., Malotte, K., Iatesta, M., Kent, C.,
Lentz, A., Graziano, S., Beyers, R.H., Peterman, T.A., for the Project
RESPECT Study Group. (1998). Efficacy of Risk-Reduction Counseling to
Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases:
A Randomized Controlled Trial. Journal of the American Medical
Association, 280:1161-67 .
Program Review Panel Information
The
CDC requires all CDC-funded agencies using the RESPECT intervention to
identify, or establish, and utilize a Program Review Panel and complete
Form 0.1113 to document this activity. The intervention researchers and
developers are not involved in this activity. This is a CDC requirement
for their grantees, and all questions in this regard should be directed
to your agency's CDC Project Officer or to the health department
funding your agency's implementation of the intervention.
The Program Review Panel guidelines, instructions for completion of Form 0.113, and the form itself are available under the
Related Links section of this website.