Risky behaviour can be modified

BMJ 1998; 316 doi: (Published 27 June 1998) Cite this as: BMJ 1998;316:1927
  1. Terri Rutter
  1. Boston

    Many campaigns have encouraged safer sex, but few data have shown whether such campaigns work. Now a study from the US National Institute of Mental Health suggests that such interventions can change sexual behaviour and reduce the risk of HIV transmission even in high risk groups.

    The largest randomised controlled study ever conducted in the United States on the subject showed that extensive counselling and education can reduce high risk behaviour by half (Science 1998;280:1889-94).

    The study involved 3706 men and women from 37 inner city, free health clinics—75% of the participants were African American or Hispanic, and 70% were unemployed. “Behaviour intervention can make a difference even in minority disadvantaged populations,” said Dr Steven Hyman, director of the National Institute of Mental Health.

    Nearly all the study participants engaged in behaviour that put them at high risk of being infected with HIV—such as intravenous drug use, having multiple sexual partners, or having sex with someone who they knew or believed was HIV positive. Nearly half said that they did not use condoms regularly.

    Study participants were randomly assigned to two equal groups. The control group received standard education about HIV prevention—a one hour session that included a video and a question and answer period. Participants in the intervention group participated in seven counselling and education sessions in small groups, each session lasting one and a half to two hours; participants in these groups were told how to reduce their risk of infection and how to change the behaviours that put them at risk.

    Over the next year each group reported more frequent use of condoms. The greatest behavioural changes, however, were seen in the group receiving the intervention. The use of condoms in this group increased from 23% to 60%, compared with 21% to 48% in the control group.

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