Behavioral Intervention Results in Safer Sex Practices for Persons Living with HIV in South Africa

Options for HealthResearch conducted at 16 HIV clinical care sites in KwaZulu Natal, South Africa shows the pairing of a theory-based behavioral intervention with clinical care treatment for persons living with HIV resulted in more safer sex practices (measured by incidence of sex with condoms), compared to patients who did not receive the behavioral intervention. Increased safer sex practices among those living with HIV can help stem the spread of the HIV epidemic in South Africa, and can protect those living with HIV from other pathogens.

In the NIMH-funded Options for Health Randomized Trial, an international collaboration between researchers and clinicians from the University of Connecticut, University of Toronto, Nelson Mandela School of Medicine in Durban South Africa, Yale School of Medicine, and the University of Western Ontario, Canada, HIV+ patients on antiretroviral therapy (ART) met with a trained lay counselor employed at the clinic at each clinical care visit. During this session, half of the almost 1900 patients received a behavioral intervention first shown to be effective in a similar context in the U.S. by Dr. Jeffrey Fisher of CHIP and his research team. The intervention was carefully adapted to the South African culture, risk dynamics, and clinical care setting. The other half of the patients received standard-of care counseling. The behavioral intervention was based on the Information-Motivation-Behavioral Skills (IMB) model published by Fisher and Fisher (1992) which assumes that when individuals have sufficient safer sex information, motivation, and behavioral skills, they will adopt and maintain safer sex behavior.

The patients given the IMB model-based behavioral intervention reported significantly fewer incidents of unprotected sex in the previous four weeks at six month, twelve month, and eighteen month assessment interviews than those exposed to the standard of care.

Dr. Jeffrey Fisher, Distinguished Professor and founding Director of UConn’s Center for Health, Intervention, Prevention (CHIP) said the study demonstrated that “linking an effective HIV transmission prevention intervention to the clinical care context can reach large numbers of people living with HIV at low cost. Scaling it up as the standard-of-care in South African clinical care settings could have a significant impact on the HIV epidemic in that country.” Further, “ this type of behavioral intervention can be an important adjunct to ‘treatment as prevention’ since significant numbers of individuals living with HIV do not adhere to ART, have detectable viral load, and practice risky sex,” Fisher said. The South African Options for Health Randomized Trial was funded by a $6.3 million grant from the National Institute of Mental Health to the University of Connecticut. Fisher’s collaborators included Deborah Cornman, Paul Shuper, Sarah Christie, Sandy Pilay, Susan MacDonald, Ntombenhle Ngcobo, Rivet Amico, Umesh Laloo, Gerald Friedland, William Fisher, and the South African Options Team.

By Samantha Libby

Intervention Resources: More information about the South Africa Options intervention can be found at: