HIV counseling for behavior change

Abstract

The purpose of this paper was to provide a framework for discussion in the working group on HIV Counseling for Behavior Change at the Third USAID HIV/AIDS Prevention Conference. The paper begins with a section defining HIV counseling and describing different types of HIV counseling. Next, points of consensus and controversy regarding the conduct and evaluation of HIV counseling are discussed. This is followed by a section outlining findings to date on the effectiveness of HIV counseling, and a discussion of methodological issues in evaluating counseling outcomes. Finally, the paper includes a list of key issues for further research.

PIP: HIV counseling entails the development of a relationship between a counselor and client for the purpose of assessing risk for HIV infection or transmission, developing a plan to reduce risk, and assisting the client to cope with emotional and interpersonal issues related to HIV. The goal of client-centered HIV counseling is to conduct an individualized risk assessment, which may or may not include HIV antibody testing, and to develop an effective individualized risk reduction plan. Evaluation of the effectiveness of HIV counseling has been impeded by a lack of adequate outcome measurement instruments and concerns about the validity of self-reported behaviors. However, the available research suggests that counseling interventions are most successful when accompanied by access to prevention technology (e.g., condoms, clean syringes), skill building, and enhancement of peer group and community norms. Critical research needs include definition of the mechanisms that facilitate enduring behavioral change, assessment of the cost-effectiveness of counseling, and identification of the structural and environmental barriers to effective counseling interventions.