Examining the efficacy of HIV risk-reduction counseling on the sexual risk behaviors of a national sample of drug abuse treatment clients: Analysis of subgroups.

HIV counseling with testing has been part of HIV prevention in the U.S. since the 1980s. Despite the long-standing history of HIV testing with prevention counseling, the CDC released HIV testing recommendations for health care settings contesting benefits of prevention counseling with testing in reducing sexual risk behaviors among HIV-negatives in 2006. Efficacy of brief HIV risk-reduction counseling (RRC) in decreasing sexual risk among subgroups of substance use treatment clients was examined using multi-site, randomized controlled trial data from NIDA Clinical Trials Network protocol CTN-0032.

Interaction tests between RRC and subgroups were performed; multivariable regression evaluated the relationship between RRC (with rapid testing) and sex risk. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. There was an effect (p < .0028) of counseling on number of sex partners among some subgroups.

Conclusions: Results of the analyses on total number of partners suggest that brief, client-centered HIV risk-reduction counseling may be efficacious in reducing total number of sex partners among low-risk participants (e.g., those with no baseline risky sex and those already consistently using condoms) in substance use treatment. However, because the majority of subgroups investigated did not report fewer sexual risk behaviors (acts or partners), the overall findings of this study lend support to the CDC’s 2006 recommendation to provide routine HIV testing without requiring HIV risk-reduction counseling at the time of testing. Findings should be viewed with caution given the number of post hoc subgroup analyses that were performed.