Personalized Cognitive Counseling (PCC) A Single Session Intervention for MSM Who Are Repeat Testers for HIV

The Research

The Science Behind the Package

Personalized Cognitive Counseling (PCC) is a single session counseling intervention designed to reduce high-risk behaviors among men who have sex with men (MSM) who are repeat testers for HIV. The PCC intervention is based on the work of cognitive psychologist Ron Gold and colleagues, hypothesizing that the decision to engage in high-risk sex happens when the person rationalizes the potential risk by minimizing the known risk.

Target Population
PCC is for MSM who are HIV-seronegative, who have had at least one HIV test before, and who report unprotected anal intercourse (UAI) in the past 12 months with a partner of unknown HIV serostatus or a partner who was HIV-positive. The intervention is for men 18 years of age or older of any race/ethnicity.

Intervention
PCC is delivered in the context of HIV test counseling in a 30 to 50 minute individual session. Typically the setting is a community HIV testing site. Counselors should be trained in HIV prevention counseling and testing and have at least one year of experience conducting HIV counseling. The process is aided by the PCC Questionnaire, a list of self-justifications that men often use to rationalize risky behavior. PCC is a five step process: 1) The client is assisted to recall a memorable episode of UAI. 2) The client completes the PCC Questionnaire with the specific incident in mind. 3) The counselor draws out the client’s story about the incident, along with the thoughts and feelings the client experienced. 4) The counselor helps the client identify the self-justifications that facilitated the UAI. 5) The counselor asks the client what he will do in future similar situations to avoid risk.

Research Results
Two controlled studies of PCC were conducted at the AIDS Health Project (AHP) in San Francisco. In the first study, participants were 248 MSM eligible for PCC. Two intervention groups received standard HIV test counseling plus the PCC cognitive behavioral intervention, delivered by mental health professionals, and two control groups received only standard HIV test counseling. A second similar study tested PCC versus standard HIV test counseling using experienced bachelors-level HIV test counselors who were trained in the PCC intervention. Participants were 336 MSM who were randomly assigned to PCC or standard HIV counseling in the second study. In both studies, the PCC intervention significantly reduced the number of UAI episodes with non-primary HIV-positive or unknown status partners in the six months after counseling. In the first study, the average number of unsafe episodes significantly declined by about half at six month follow-up and maintained 12 months later. Men who participated in the second study were asked how helpful they found the services; those who received PCC were more satisfied with the services received.

For Details on the Research Design
Dilley JW, Woods WJ, Sabatino J, Lihatsh T, Adler B, Casey S, et al. (2002). Changing Sexual Behavior Among Gay Male Repeat Testers for HIV: A Randomized, Controlled Trial of a Single-Session Intervention, Journal of Acquired Immune Deficiency Syndromes, 30(2), 177-86.

Dilley JW, Woods WJ, Loeb L, Nelson K, Sheon N, Mullan, J, et al. (2007). Results From a Randomized Controlled Trial Using Paraprofessional Counselors. Journal of Acquired Immune Deficiency Syndromes, 44(5), 569-577.

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. PCC is one of the REP interventions. The PCC intervention package is the product of extensive collaboration among researchers, training developers, community service providers, and community-based agencies. The intervention has been field tested in two community 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 PCC include:

1. Provide one-on-one counseling focusing on a recent, memorable high risk sexual encounter.
2. Provide the service with counselors trained in HIV counseling and testing and in the PCC intervention.
3. Use the questionnaire specifically tailored to identify key self justifications used by clients in the target population.
4. Using the questionnaire and discussion, identify specific self-justifications used by clients in making the decision to engage in specific high-risk behavior.
5. Explore the circumstances and context for the risk episode in detail (before, during and after).
6. Clarify how the circumstances and self-justifications are linked to the decision to engage in high-risk behavior.
7. Guide the clients to re-examine the thinking that led to their decision to have high-risk sex and identify ways they might think differently, and therefore have protected sex in future potentially risky situations.

Package Contents
PCC Implementation Manual with guidance and materials for implementation.

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

For More Information on the PCC Intervention Package
To find out more about future trainings, please visit Effective Interventions.