EFFECT OF THE ENHANCED HIV COUNSELING ON STUDENTS TESTING NEGATIVE FOR HIV/AIDS
Open Access
- Author:
- Okoror, Titilayo Ainegbesua
- Graduate Program:
- Biobehavioral Health
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- July 14, 2006
- Committee Members:
- Collins O Airhihenbuwa, Committee Chair/Co-Chair
Edward A Smith, Committee Member
Edgar Paul Yoder, Committee Member
Patricia Barthalow Koch, Committee Member - Keywords:
- HIV counseling
college students
cultural models
HIV risk behaviors
African Americans
socio-cultural factors
cultural identity
skills-training
telephone counseling
self-managment - Abstract:
- College students are at increased risk for HIV/AIDS because of perceived invulnerability to HIV, and increasingly engaging in HIV risk behaviors by having multiple sexual partnerships, unprotected sexual intercourse and using alcohol in many of these situations. African American college students are at even higher risk for HIV due to some cultural beliefs and misconceptions. Although HIV counseling and testing is considered a primary line of defense in reducing HIV transmission, models on which such services are based do not explore socio-cultural contexts within which HIV behaviors takes place. Use of a cultural model that explores the socio-cultural contexts of students’ behaviors may provide more insight into factors that either enable them to, or prevent students from engaging in HIV risk reduction behaviors. In addition, providing students with the necessary skills to negotiate such contexts along with daily management of their behaviors may prove effective in reducing HIV risk behaviors. The purpose of this study was to examine the effect of the Enhanced HIV counseling program in reducing HIV risk behaviors by increasing condom use, reducing the number of sexual partners, and alcohol use, as compared to the Standard HIV counseling program (brief counseling) currently offered at the Penn State University Park campus. Using mixed approaches of behavioral surveys and content analysis of semi-structural interviews, opinion guides and field-notes, the study specifically compared the effectiveness of the Enhanced HIV Counseling program with the Standard Counseling program in reducing HIV risk behaviors; determined which component(s) of the Enhanced counseling was most effective, and explored socio-cultural factors identified by students that prevent them or enable them to engage in HIV risk reduction. Using the PEN-3 model as a guide, the Enhanced HIV counseling consisted of forty minutes of pre-test counseling on skills training on condom application, negotiating safer sex, and exploring socio-cultural factors; followed by the actual HIV testing. Participants were also provided with self-monitoring logs to complete daily and drop off at the end of each week for the duration of the study. Participants also received twenty minutes of post-test counseling based on completed logs when they returned for their HIV test results, and five minutes of telephone counseling support at nine weeks into the study. The Standard Counseling comprised of twenty minutes of pre-test counseling’s assessment of risks, and development of behavioral goals, followed by the actual HIV testing, and a ten minutes post-test counseling when students returned 3 weeks later to receive their HIV test results. Main outcomes of interest were participants’ knowledge about HIV/AIDS; reduction in number of sex partners, use of alcohol and increase in condom use during last sexual encounter; the most effective component in the Enhanced HIV counseling program and socio-cultural factors identified by students’ as supportive of, or impediments to reducing HIV risk behaviors. Students using the off-site testing locations were recruited to participate in the study. Of the 108 students using the off-site testing locations, fifty students agreed to participate in the study, and were randomly assigned to receive the Enhanced HIV counseling or the Standard HIV counseling. Participants were equally distributed into both study groups, were mostly African Americans (68%), females (64%) and single (66%). Participants’ knowledge about HIV/AIDS increased at post-treatment when compared with pre-treatment, although this was not statistically significant. Cross-tabs analysis showed that more participants in the Enhanced Counseling group reported a reduction in the number of sex partners in comparison to participants in the Standard Counseling group. In addition, more participants in the treatment group reported less use of condoms and more alcohol use at last sexual encounter when compared to those in the Standard Counseling group. However, these results were not statistically significant. Content analysis of the semi-structural interviews showed that equal number of the participants’ selected the skills training and self-monitoring logs as effective components of the Enhanced HIV counseling. Only one participant selected the telephone counseling, and one participant selected both the skills training and self-monitoring logs. Using the PEN-3 model, cultural identity, sexual satisfaction and perception of body image were socio-cultural issues that enabled and/or prevented participants from engaging in HIV risk reduction behaviors.