May 2, 2008

“Video Doctor” Reduces Unsafe Sex and Drug Use

People living with HIV who received computerized video risk-reduction counseling before following up with a live doctor had less unprotected sex and used fewer illicit drugs than those who did not, according to the authors of a study published April 23 in the online journal PLoS One.

Although the Centers for Disease Control and Prevention (CDC) recommends health care providers counsel their HIV-positive patients about safer sex practices and drug use, research has shown many doctors do not follow these suggestions. Reasons providers give for not conducting such discussions range from feeling uncomfortable with the topics to limited time with their patients during routine medical exams.

To test the effectiveness of prevention interventions conducted largely through computerized videos, Paul Gilbert, ScM, and his colleagues from the University of California, San Francisco, enrolled 476 people living with HIV who had reported substance use, or unprotected anal or vaginal sex. The study participants were recruited predominantly at HIV clinics and hospitals in or near San Francisco. Most of the volunteers were male. Approximately half were black, and half were men who have sex with men.

At the start of the study, the participants completed extensive assessments of their sexual histories and drug- and alcohol-taking behaviors. The assessments were completed again at two future intervals, each three months apart and always just before a regular doctor’s appointment. In addition, half the study volunteers were asked to participate in a virtual, computerized counseling session where a doctor, played by an actor, guided them through a series of discussions about unprotected sex and substance or alcohol use. After the intervention, participants received a personalized printed worksheet outlining their risks, and their health care providers received “cue sheets” with suggestions to encourage further discussion.

Gilbert’s team found that the group who participated in the computerized intervention reported 20 percent fewer unprotected sexual encounters six months later, compared with the group who did not receive the intervention. Recreational drug use also dropped significantly in the intervention group compared with the non-intervention group.

Because both participants and their health care providers responded positively to the intervention, and because the intervention proved successful at changing behavior, the authors conclude that computerized prevention efforts like theirs may be easily integrated into regular medical practice and could be a useful addition to standard HIV care.

Search: UCSF, San Francisco, CDC, Paul Gilbert, video, prevention for positives

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