An HIV/AIDS prevention program developed by researchers at the Center for Health, Intervention and Prevention (CHIP) has been selected as one of the country’s top HIV/AIDS interventions by the U.S. Centers for Disease Control and Prevention (CDC).
“Options” was developed by a team led by Jeffrey Fisher, a professor of social psychology in the College of Liberal Arts and Sciences and director of CHIP. The Options intervention focuses on “prevention with positives.” It trains clinicians to talk with HIV-positive patients during routine medical appointments about reducing their risky sexual and drug use behavior, using behavior change theory and motivational interviewing techniques.
The clinicians work collaboratively with patients in assessing their risky behaviors and willingness to change. Together, clinician and patient then develop strategies for practicing safer behavior, and set future goals that are written out in a “prescription” for safer sex or drug use.
Interventions that work
Officials at the CDC selected Options as one of eight interventions being added this year to The 2008 Compendium of Evidence-Based HIV Prevention Interventions. The CDC publishes the compendium annually to highlight programs that have been scientifically proven to reduce HIV or STD-related risk behaviors or promote safer behaviors. The compendium is a source of information that informs state and local HIV prevention programs about what works for preventing HIV infections. It includes a total of 57 interventions.
“We’re very pleased it was selected as one of a relatively small number of highly promising interventions,” says Fisher. “Options is one of the very few interventions that exist to help people with HIV not to engage in practices that could spread the virus.”
Fisher notes that, while much attention has been given over the years to preventing HIV/AIDS in people who don’t have it, there is increasing interest in focusing prevention efforts on individuals who are already infected.
“About one-third of the people with HIV practice risky behaviors,” he says. “We have to work together with them to help them be safer. Having HIV and engaging in risky behavior is a way to spread the virus, yet we’ve been neglecting this population since the beginning of the epidemic.”
Fisher says the Options model can be used to promote healthier behavior for other populations too, such as those with diabetes.
“Getting people to change is not easy. Getting people to maintain that change over time is even more difficult,” he says. “One of the unique things about Options is that it recognizes that people with HIV may go in and out of risk. Sometimes they may be engaging in risky behavior, sometimes they may not, and how you intervene with them should be a function of what is happening in their lives at the time. The fact that Options is a collaboratively-designed intervention that can occur at each medical visit makes it very powerful and long-lasting.”
Health behavior change
With its roots in HIV prevention, CHIP is an interdisciplinary research center dedicated to studying and promoting health behavior change in at-risk populations across multiple health domains. Since 1989, Fisher has received more than $22 million in federally-funded research grants dedicated to the reduction of HIV/AIDS globally.
Options is the third HIV/AIDS intervention developed by CHIP researchers to be included in the CDC’s compendium. Two HIV prevention interventions developed by another CHIP principal investigator, social psychology professor Seth Kalichman, were incorporated into the compendium several years ago.
Kalichman’s Healthy Relationships is a small-group, skills-based behavioral intervention for men and women living with HIV. The intervention helps HIV-positive individuals develop skills for handling HIV-related stresses and risky sexual situations and ultimately helps them develop strategies for maintaining fulfilling relationships while protecting themselves and their partners. More than 300 public health agencies around the country have been trained in implementing it.
Kalichman’s other recognized intervention is a video-based, motivational skills-building, small-group intervention for heterosexual, sexually active African American men living in urban areas. It is designed to improve communication skills and help individuals eliminate or reduce risky sexual behaviors.
The Options intervention was developed, implemented, and evaluated by Fisher in the late 1990’s in collaboration with his brother, Bill Fisher, a professor at the University of Western Ontario; Dr. Gerald Friedland, a professor and infectious disease doctor at Yale University; Deborah Cornman, a clinical psychologist and associate director of CHIP; and K. Rivet Amico, an assistant research professor in clinical psychology and CHIP affiliate.
In a study conducted between October 2000 and August 2003 involving 497 HIV-positive patients recruited from two Connecticut HIV clinics, researchers found risk behavior by HIV-positive patients decreased significantly among those participating in the Options program, while it increased for those not receiving the intervention.
With funding from the U.S. Health Resources and Service Administration, Options was expanded successfully to 15 healthcare facilities throughout the country. In the State of New York, all healthcare facilities that receive Ryan White funding must provide HIV prevention counseling to HIV-positive patients, and Options is the recommended intervention.
Options is also being implemented in eight HIV clinics in South Africa, and in military hospitals in Mozambique and Uganda.
CHIP media relations specialist Beth Krane contributed to this article.