HIV prevention counseling may be a classic case of "in one ear, out the other."
A recent report in the Journal of the American Medical Association concluded that HIV prevention counseling paired with HIV testing does little to actually keep patients from contracting new sexually transmitted diseases.
In fact, a group of patients studied in this paper who received counseling at the time of their HIV tests contracted virtually the same number of STDs six months down the road as another group that had received no counseling.
Louise Haynes, an assistant professor at the Medical University of South Carolina, co-authored the report. She agreed to answer a few questions about her work.
Question: Why did the authors set out to study the effectiveness of HIV counseling?
Answer: In 2006, the CDC modified its guidelines for HIV testing and recommended routine non-risk-based opt-out HIV screening. The guidelines removed the requirement for costly prevention counseling as part of screening in an effort to reduce barriers to testing. However, this change was based on little evidence regarding the effectiveness of counseling.
To examine the question of the effectiveness of HIV risk-reduction counseling as part of testing, the authors first conducted a study that demonstrated that counseling at the time of testing did not change risk behaviors in individuals seeking substance abuse treatment. Expanding on their initial study, the current trial was designed to determine if counseling at the time of testing would have an impact on the acquisition of new STDs among a high-risk population seeking STD treatment.
Q: What was the main conclusion that the group found at the end of the study?
A: There was no significant difference in STI (sexually transmitted infection) incidence for those who received counseling and those who did not. Counseling at the time of testing added significant cost without demonstrated benefit.
Q: What recommendations can clinicians draw from this paper?
A: These study findings demonstrate that risk-reduction counseling does not significantly impact STD clinic patients' risk of STI acquisition and suggests that there is no added benefit of brief client-centered risk-reduction counseling at the time of rapid HIV testing.
The implication of this finding for clinicians is that rather than devote resources to routine counseling for everyone receiving testing, those resources could be used more effectively to help connect patients who test positive to appropriate medical care. Counseling is also appropriate when a patient asks for counseling to address high risk behaviors.
Q: Even though the paper calls into question the effectiveness of HIV counseling paired with testing, is there still an appropriate venue for counseling? Where might it be effectively employed?
A: The study demonstrated that requiring counseling as part of testing is not necessary, but that is not to say that there is no place for counseling. It is essential that individuals who test positive for HIV have supportive counseling and services that connect them to medical care.
Q: Is counseling any more or less important in Southern states like South Carolina, with higher rates of HIV/AIDS?
A: The study found no differences in outcome by site. In other words, there was no evidence that counseling was more effective at a site in the South, than in other parts of the country.
The full report is available online, www.jama.com.
Reach Lauren Sausser at 937-5598.
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