From theory to practice: Use of stage of change to develop an STD/HIV behavioral intervention: Phase 2: Stage-based behavioral counseling strategies for sexual risk reduction Original Research Article

In the first 15 years of the HIV epidemic, client education alone has not resulted in sustained sexual and substance use behavior change needed for primary prevention. More recently, interventions grounded in social and behavioral science have demonstrated efficacy in the primary prevention of HIV and other sexually transmitted diseases (STDs). Many barriers exist, however, in the implementation of research-proven behavioral interventions in real-world settings. This paper describes an adaptation of the Stage of Change/Transtheoretical Model (SOC/TTM) to develop a stage-based method of counseling that is currently being used to promote sexual and substance use behavior change for reducing the risk of acquiring STDs and HIV. This behavioral counseling intervention, named Rochester STD/HIV Behavioral Counseling (RoSHBeC), was developed for front-line providers who deliver STD/HIV prevention interventions to at-risk individuals in both clinical and community-based settings. A systematic method for assessing SOC, previously described in , provides the basis for the selection of practical counseling strategies adapted from the processes of change described in the TTM. The present paper traces our efforts to develop these counseling strategies specific to sexual behaviors and illustrates their use in 12 common clinical cases (STD/HIV-prevention counseling sessions). The RoSHBeC behavioral counseling intervention can also be used to influence other health-related behaviors at individual and group levels. The steps of RoSHBeC provide a structured psychological intervention that is grounded in social and behavioral science (SOC/TTM) and is practical enough to be delivered by a wide variety of providers with limited formal training in counseling and behavioral treatment methods.