1. HIV INTERVENTION FOR PROVIDERS (HIP) Principal Investigators:  Carol Dawson Rose, RN, Ph.D. and Grant Colfax, MD. Co-Investigators:  Cynthia Gomez, Ph.D., Kelly R. Knight, Med Director: Nicholas J. Alvarado, MPH Field Coordinator: Pat Borch Project Coordinator: Charles Pearson, MA

2. The HIP Study is a collaboration between  Center for AIDS Prevention Studies,  San Francisco Department of Public Health  Center for Disease Control and Prevention Collaborating Clinics  Cares Clinic  San Mateo County Edison Clinic  Positive Health Program at WD 86 and UCSF Goal: To increase the skills of HIV providers in conducting risk assessments and providing brief prevention messages to their HIV infected patients.

3. Background HIV and STD incidence is increasing in urban settings Studies report HIV risk behavior among HIV infected individuals who are in care CDC Advancing HIV Prevention Initiative Brief provider interventions focused on changing patients’ risk behaviors have shown to be effective

4. Study Objectives  Develop, pilot, and implement a primary care provider prevention intervention  Conduct a controlled trial of 30-50 primary care HIV providers randomized into one of two conditions  Evaluate and compare the effects of the intervention on the HIV risk behaviors of 450 HIV infected patients of participating providers  Evaluate the effect of the intervention on provider attitude and behavior

5. Study Participants Recruited 44 primary providers from 4 clinics Licensed MD, NP, PA on staff at the participating institution Minimum panel of 5 patients & 1/2 day per week Recruiting 450 patients at these 4 clinics HIV+ Women and men, 18 years or older who have had anal or vaginal sex with HIV negative or unknown status partner in the preceding 6 months

6. Data Assessment  Baseline Assessments (patients and providers)  Three and six month follow-up assessments (patients)  Six month follow-up (provider)  ACASI survey in English and Spanish  Medical record review

7. Intervention Format 2 two-hour training sessions/Booster  First Session  Introduce assessment model (CAPRA)  Skills building, risk assessment and harm reduction based prevention message  Second Session  Implementation follow up  Condom Skills, Disclosure and Partner Notification One-hour Booster session one month post intervention

8. Preliminary Baseline Data *As of 4/8/05 Patient Participants (N=283) Median age: 43 (range 22-67) Race: African-American 37% (106), Latino 18% (50), White 36% (103), API 1% (3), mixed/other 6% (18), Sex: male 70% (197), female 26% (74), transgender 4% (12) Education: 27% have less than a high school degree

9. Preliminary Baseline Data (continued) Sexual Identity: Male: Gay 55% (109), straight 26% (52), bisexual 14% (28) other 4% (8) Female: Straight 78% (58), bisexual 16% (12), gay 4% (3), other 1% (1) Transgender (MTF): Straight 41% (5), gay 33% (4), bisexual 0% (0) other 25% (3)

10. Baseline Sexual Risk Behavior (Preliminary Data) Unprotected Anal or Vaginal Sex (past 6 months) Men: 55% ( 109 ) reported unprotected anal or vaginal sex with either male or female partners  44% (86) reported unprotected anal sex with male partners  13% (26) reported unprotected anal/vaginal with female partners Women: 56% (41)reported any unprotected anal/vaginal with male partners

11. Injection Drug Use Risk (preliminary Data) 33% (93) reported injection drug use in the past 28% (79) reported injection related risk with serodiscordant partner

12. Relationship with Provider (Preliminary Data)  50% of patient participants had six visits with provider in last year  Time spent with provider during last visit 32% greater than 30 minutes  During last visit, 60% reported provider asked if they were sexually active

13. Challenges  Multiple Clinic-Based Prevention Programs  Computer literacy of patient participants  Spanish Language Barriers  Scheduling Providers for intervention

14. Big Study Question Can we change behavior practices of HIV providers to better assess and reduce transmission risk with their HIV+ patients to partners of negative or unknown status? Do people who are patients at HIV clinics want to talk about prevention with their providers? For further inquiries contact: Carol Dawson Rose at cdawson@psg.ucsf.edu orcdawson@psg.ucsf.edu Nicholas Alvarado at nalvarado@psg.ucsf.edu