| Study, Year (Reference) |
Study Quality |
Setting |
Study Sample |
Counseling Intervention |
Follow-Up, % |
Outcome at 12-mo Follow-Up* |
Adverse Outcomes |
| Adults with biological outcomes |
| Petersen et al., 200714 |
Fair (minor concerns about reporting) |
PC (FP) clinics |
n=737; age range, 16—44 y; 0% male; 27% black |
Pregnancy and STI risk reduction based on motivational interviewing
IG1: moderate or high—unknown duration; 2 (individual) sessions
CG: single-session general health promotion counseling |
8 mo: 91; 12 mo: 87 |
STI-positive (for chlamydia):
Total: 1%; NS differences between groups, data not shown
STI-positive (for any other STI by self-report or chart review):
Total: 8%; NS differences between groups, data not shown |
No increase in unprotected sex or decrease in condom use; no increase in STI incidence (by self-report, chart review, or testing) |
| Jemmott et al., 200713 |
Good |
Women's health clinic(hospital-based) |
n = 564; mean age, 27 y; 0% male; 100% black; 20% with STI (current) |
Culturally tailored, skills-based intervention based on social cognitive
behavioral theory
IG1: high—200 min total; 1 group session
IG2: low—20 min total; 1 individual session
CG: matched general health promotion counseling |
6 mo: 90; 12 mo: 87 |
STI-positive (for gonorrhea, chlamydia, trichomonas), adjusted:
IG1: 15%
IG2: 14%
CG: 27%; P = 0.03 (IG1 and IG2 vs. CG) |
No increase in unprotected sex or decrease in condom use; no increase in STI incidence (by testing) |
| Shain et al., 200415; Project SAFE 2 |
Fair (groups slightly different at baseline, minor concerns about reporting) |
STI clinic |
n = 775 (690 in analysis); mean age, 21 y; 0% male; 23% black; 77% Hispanic; 100% with STI (current) |
Culturally tailored ARRM
IG1 and IG2: high—9 h total; 3 group sessions ± optional support group sessions
CG: usual care, 15-min counseling |
12 mo: 91; 24 mo: 91 |
STI-positive (for gonorrhea, chlamydia), adjusted:
IG1: 15.7%; P = 0.006; OR, 0.51 (95% CI, 0.31–0.83)
IG2: 15.4%; P = 0.004; OR, 0.50 (CI, 0.31–0.80)
CG: 26.8% |
No increase in number of sex partners; no increase in STI incidence (by testing) |
| Shain et al., 199916; Project SAFE |
Good |
STI clinic |
n = 617 (549 in analysis); mean age, 21 y; 0% male; 31% black; 69% Hispanic; 100% with STI (current) |
Culturally tailored ARRM
IG: high—9 to 12 h total; 3 group sessions
CG: usual care, 15-min counseling |
6 mo: 82; 12 mo: 89 |
STI-positive (for gonorrhea, chlamydia), adjusted:
IG: 16.8%; P = 0.004; OR, 0.52 (CI, 0.34–0.81)
CG: 26.9% |
No increase in unprotected sex or decrease in condom use; no increase in STI incidence (by self-report) |
| Kamb et al., 199817; Project RESPECT |
Fair (suboptimal follow-up) |
STI clinics |
n = 5758; median age, 25 y; 57% male; 59% black; 19% Hispanic; 6% other nonwhite; 32% with STI (current) |
Enhanced CDC's client-centered HIV prevention counseling model
IG1: high—200 min total; 4 individual sessions
IG2: moderate—40 min total; 2 individual sessions
CG: usual care, 10-min information only |
6 mo: 70; 12 mo: 66 |
STI-positive (for gonorrhea, chlamydia, syphilis, HIV), adjusted:
IG1: 11.5%; RR, 0.78 (CI, 0.64–0.94)
IG2: 12.0%; RR, 0.81 (CI, 0.67–0.98)
CG1: 14.6% |
No increase in number of sex partners; no increase in unprotected sex or decrease in condom use; no increase in STI incidence (by testing) |
| Boyer et al., 199718 |
Fair |
STI clinics |
n = 393; age range, 18–35 y; 67% male; 46% black; 15% Hispanic; 10% other nonwhite; 62% with STI Hx |
ARRM
IG: high—4 h total; 4 individual sessions
CG: usual care, 15-min counseling |
Within 6 mo: 72 |
STI-positive at 6 mo (for any STI):
IG: 6.8% (male); 21.8% (female); P = NS
CG: 7.0% (male); 22% (female) |
No increase in number of sex partners; no increase in unprotected sex acts; no increase in STI incidence (by self-report) |
| Carey et al., 200419 |
Fair (minor concerns about reporting) |
Psychiatric clinic |
n = 408; median age, 36 y; 46% male; 21% black; 38% with STI Hx |
HIV harm reduction model and motivational techniques
IG: high—unknown total hours; 10 group sessions
CG1 and CG2: matched substance abuse counseling or usual care |
6 mo: 89; 9 mo: 88 |
Self-report (at 6 mo) of new STI diagnosis at 6 mo, adjusted:
IG: 2%
CG1: 8%; P < 0.013
CG2: 5%; P < 0.046 |
No increase in number of sex partners; no increase in unprotected sex or decrease in condom use; no increase in STI incidence (by self-report) |
| Scholes et al., 200320 |
Fair (minor concerns about reporting) |
Medical clinics (managed care practice) |
n = 1210; mean age, 21 y; 0% male; 19% black; 12% other nonwhite; 27% with STI Hx |
Individually tailored self-help printed materials based on multiple social science theories
IG: low—2 mailings: 12-page booklet and booster newsletter
CG: usual care, details NR |
6 mo: 86 |
Self-report (at 6 mo) of STI diagnosis in past 3 mo; adjusted:
IG: 3%; P = 0.93; OR, 0.97 (CI, 0.48–1.96)
CG: 3.6% |
No increase in unprotected sex or decrease in condom use; no increase in STI incidence (by self-report) |
| Adolescents with biological outcomes |
| Jemmott et al., 200522 |
Good |
Adolescent medicine clinic (hospital-based) |
n = 682 (235 in IG1); mean age, 15 y; 0% male; 68% black; 32% Hispanic; 22% with STI (current) |
Culturally tailored, skills-based intervention based on cognitive behavioral theories
IG1 and IG2: high—250 min total; 1 group session ± skills training
CG: matched general health promotion counseling |
6 mo: 93; 12 mo: 89 |
STI-positive (for gonorrhea, chlamydia, trichomonas), adjusted:
IG1: 10.5%; P = 0.05
IG2: 14.4%; P = 0.44
CG: 18.2% |
No increase in number of sex partners; no increase in unprotected sex or decrease in condom use; no increase in STI incidence (by testing) |
| DiClemente et al., 200423 |
Good |
Community health clinics |
n = 522; mean age, 16 y; 0% male; 100% black; 17% with chlamydia (current) |
Culturally tailored social cognitive theory and theory of gender and power, with peer co-facilitators
IG: high—4 h total; 4 group sessions
CG: matched nutrition and exercise counseling |
6 mo: 90; 12 mo: 88 |
STI incidence per 100 person-months (crude) and OR (adjusted):
Chlamydia:
IG: 2.1; CG: 2.0
OR, 0.17 (CI, 0.03–0.92)
Gonorrhea:
IG: 0.9; CG: 0.7
OR, 0.14 (CI, 0.01–3.02)
Trichomonas:
IG: 0.9; CG: 1.2 OR,
0.37 (CI, 0.09–1.46) |
No increase in unprotected sex or decrease in condom use; no increase in STI incidence (by testing) |
| Kamb et al., 199817; Bolu et al., 200424; Project RESPECT |
Fair (suboptimal follow-up) |
STI clinics |
n = 764 (subgroup analysis of 5758); subgroup age <20 y |
Enhanced CDC's client-centered HIV prevention counseling model
IG1: high—200 min total; 4 individual sessions
IG2: moderate—40 min total; 2 individual sessions
CG: usual care, 10-min information only |
NR |
STI-positive (for gonorrhea, chlamydia, syphilis, HIV), adjusted:
IG1: 17.2%; RR, 0.57 (CI, 0.37–0.90)
IG2: 17.5%; RR, 0.58 (CI, 0.37–0.92)
CG1: 26.6% |
No increase in STI incidence (by testing) |
| Boekeloo et al., 199921 |
Fair (minor concerns about reporting) |
Pediatric clinics(HMO) |
n = 219; age 12–15 y (mean age NR); 50% male; 64% black; 3% Hispanic; 14% other nonwhite; 6% with STI Hx
(past 3 mo) |
Physician counseling based on 15-min audiotape risk assessment done in waiting period
IG: low—unknown total duration; "brief" individual session
CG: usual care, details NR |
9 mo: 90 |
Self-report (at 9 mo) with STI (told by physician/nurse):
IG: 0%; P = NS
CG: 2.9%
Self-report (at 9 mo) of treatment for STI:
IG: 1.1%; P = NS
CG: 5.8% |
Increase in percentage having vaginal sex at 3 mo but not at 9 mo; no increase in any (vaginal, oral, or anal) sex; no increase in unprotected sex or decrease in condom use; no increase in STI incidence (by self-report) |
| Adults with behavioral outcomes only |
Ehrhardt et al., 200225;
Hoffman et al., 200336;
Melendez et al., 200337;
Project FIO |
Good |
Planned Parenthood clinic |
n = 682; mean age, 22.3 y; 0% male; 73 black; 17% Hispanic; 58.3% with STI (previous) |
Culturally tailored ARRM
IG1: high—10 h total; 4 group sessions plus booster at 9 mo
IG2: high—18 h total; 8 group sessions plus booster at 9 mo
CG: usual care, assessment only |
6 mo: 91; 12 mo: 97 |
Condom use in past 3 mo:
IG1: NR
IG2: 18% increase (P = 0.06)
CG: NR
Model predicted mean number of unprotected acts in past 3 mo:
IG2: On average, 4 fewer UVI/UAI than control group (P = 0.00)
Maintaining or improving safer sex behavior, adjusted:
IG1: 66.4%
IG2: 72.7%
CG: 61.7%
OR (IG2 to CG), 1.65 (CI, 0.94–2.90) |
No increase in unprotected sex or decrease in condom use |
| Proude et al., 200426 |
Fair (suboptimal follow-up, minor concerns about reporting) |
FP practices; Australia |
n = 312; age range, 18–25 y; 29% male |
Physician counseling based on brief risk assessment done by FP during visit; theory not specified
IG: low—unknown total duration; "brief" individual session
CG: usual care, details NR |
3 mo: 68 |
At 3 mo, new sex partners over past 3 mo (calculated):
IG1: 7.1% (11/156)
CG: 8.3% (13/156)
At 3 mo, condom use on first sex occasion with new partner:
IG: 73% (8/11)
CG: 77% (10/13)
P = 0.813 |
No increase in number of sex partners; no increase in unprotected sex or decrease in condom use |
| Wenger et al., 199227 |
Fair (minor concerns about reporting) |
University health clinic |
n = 370; mean age, 23 y; 28% male; 61% white; 23% with STI (previous) |
"Education"; or "education" plus HIV testing; theory not specified
IG1 and IG2: moderate—1 h total; 1 group session ± HIV testing
CG: wait-list control |
6 mo: 88 |
At 6 mo, patients with UVI/UAI with last sex partner:
IG1: 68%
IG2: 63%
CG: 61%
P > 0.15
At 6 mo, mean number of sex partners in last mo:
IG1: 0.70
IG2: 0.84
CG: 0.72
P > 0.15 |
No increase in number of sex partners; no increase in unprotected sex or decrease in condom use |
| Adolescents with behavioral outcomes only |
| Danielson et al., 199028 |
Fair (minor concerns about reporting) |
HMO |
n = 1195; age range, 15–18 y; 100% male; <5% black; <4% Asian |
Slide tape program followed by session with health practitioner; theory not specified.
IG: moderate—1 h total; 1 individual session
CG: wait list control |
12 mo: 81 |
Condom use at most recent intercourse:
IG: 33.3%
CG: 35.8%
Sexually active male teenager:
IG: mean, 90%
CG: mean, 91%
Sexually active male teenager (of those not previously sexually active):
IG: mean, 30%
CG: mean, 34%
Any contraceptive use at most recent intercourse:
IG: 69.9%
CG: 65.8%
Adjusted OR, 1.51; P < 0.05
Adjusted (for those who had not been sexually active at baseline)
OR, 2.53; P < 0.01 |
No increase in unprotected sex or decrease in condom use; no earlier sexual debut |
ARRM = AIDS risk reduction model; CDC = Centers for Disease Control and Prevention; CG = control group; FP = family practice; Hx = history; IG = intervention group; NR = not reported; NS = not significant; OR = odds ratio; PC = primary care; STI = sexually transmitted infection; RR = relative risk; UAI = unprotected anal intercourse; UVI = unprotected vaginal intercourse.
* Or longest follow-up if otherwise specified.
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