Using Motivational Interviewing in HIV Field

Using Motivational Interviewing in HIV Field Outreach With Young African American.

Outlaw and colleagues sought to determine whether field outreach with motivational interviewing, as compared with traditional field outreach, leads to increases in HIV counselling and testing and rates of return for test results among young African American men who have sex with men. In a randomized, 2-group, repeated-measures design, 96 young African American men who have sex with men completed a motivational interviewing-based field outreach session and 92 young African American men who have sex with men completed a traditional field outreach session. The percentages of participants agreeing to traditional HIV counselling and testing (an oral swab of the cheek) and returning for test results were the primary outcome measures. More of the participants in the motivational interviewing condition than the control condition received HIV counseling and testing (49% versus 20%; chi(2)1=17.94; P=.000) and returned for test results (98% versus 72%; chi(2)1=10.22; P=.001). The addition of motivational interviewing to field outreach is effective in encouraging high-risk young African American men who have sex with men to learn their HIV status. Also, peer outreach workers can be effectively trained to reduce health disparities by providing evidence-based brief counselling approaches targeting high-risk minority populations.

Traditional field outreach entails a face-to-face interaction between an outreach worker and an individual in a natural environment, with a focus on delivering education and safer sex supplies. In this study, the outreach workers in the traditional group focused on risk assessment, provision of information in a nonjudgmental, respectful manner, and an offer of HIV testing and counselling. Only 20% of their clients chose to receive HIV testing and counselling compared to 49% of those who received the same field outreach as well as motivational interviewing. This consisted of assessment of readiness to learn HIV status, exploration of ambivalence about learning status with tailored education as needed, affirmation of specific strengths to boost self-confidence for behaviour change, and communication of respect for clients as the experts on their own behaviour, emphasising personal choice and responsibility. This is a small study but the results are promising and in the end make common sense. Information is not enough to move many people to overcome their ambivalence to learning their HIV status and, for those who do make the step to have a test, to returning to learn their result. The additional peer outreach worker training, involving specific client-centred micro-skills and strategies to elicit and reinforce client motivations, generates the only added costs in this approach.