Healthy Relationships: A Small-group Level Intervention for Men and Women Living with HIV/AIDS

The Research

The Science Behind the Package
  Healthy Relationships is a multisession, small-group, skills-building program for men and women living with HIV/AIDS. The program is designed to reduce participants’ stress related to safer sexual behaviors and disclosure of their serostatus to family, friends, and sex partners. The program is based on Social Cognitive Theory, which states that persons learn by observing other people successfully practice a new behavior.

Target Population
HIV-positive heterosexual men and women and HIV-positive men who have sex with men

Intervention
Groups of 5 to 12 HIV-positive participants of the same sex and sexual orientation meet in a room that allows privacy for discussion. The groups are closed to new members and are similar in style to support groups. The interactive sessions are facilitated by a licensed counselor and a peer, who may be HIV-positive. One facilitator is male, and the other is female. During the five 120-minute sessions, participants learn problem-solving and decision-making skills to address coping with stress related to safer sexual behaviors and disclosure of serostatus. Participants observe the facilitators model the skills, watch scenes from popular movies portraying characters using similar skills, and role play the scenes as though the situation pertained to safer sex negotiation or serostatus disclosure. Participants receive feedback from the facilitators and each other to encourage self-efficacy, self-evaluation, and behavior change.

Research Results
Six months after taking part in Healthy Relationships, significant numbers of participants reported:

• Less unprotected sex with non-HIV-positive partners
• Fewer sexual contacts overall
• Having refused to engage in unsafe sex

For Details on the Research Design
Kalichman SC, Rompa D, Cage M, DiFonzo K, Simpson D, Austin J, Luke W, Buckles J, Kyomugisha F, Benotsch E, Pinkerton S, and Graham J. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. American Journal of Preventive Medicine 21(2), 84-92.

The Intervention

A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that supports the translation of evidence-based HIV/AIDS prevention interventions into everyday practice, by working with the original researchers in developing a user-friendly package of materials designed for prevention providers. Healthy Relationships is one of the REP interventions and is the product of extensive collaboration among researchers who originally developed and evaluated the intervention and the community- based agencies that implemented the intervention. The package has been field-tested in six HIV prevention agencies by non-research staff.

Core Elements
Core elements are intervention components that must be maintained without alteration to ensure program effectiveness.

The core elements of Healthy Relationships include:

1. Defining stress and reinforcing coping skills with HIV-positive people across three life areas:
   • Disclosing to family and  friends,
   • Disclosing to sex partners, and
   • Building healthier and safer relationships.
2. Using modeling, role-play, and feedback to teach and practice skills related to coping with stress.
3. Teaching decision-making skills around the issue of disclosure of HIV status.
4. Providing participants with personal feedback reports to motivate change of risky behaviors and continuance of protective behaviors.
5. Using popular movie clips to set up scenarios around disclosure and risk reduction to stimulate discussions and role plays.

Package Contents

• An intervention manual to guide organizations through planning, implementation, maintenance, and evaluation of the intervention, including detailed recommendations on selecting movie clips.
• Intervention overview video and a collection of HIV education and male and female condom-use videos on a single tape.
• Risk continuum banner and cards; initial participant assessment, personal feedback, and session evaluation forms; samples of other materials; and a CD containing all written materials.

Timeline for Availability
The package is available from CDC along with training on program implementation and technical assistance.

For More Information on the Healthy Relationships Package
To find out more about future trainings, please visit http://effectiveinterventions.org.

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