AIDS and Behavior

, Volume 16, Issue 5, pp 1203–1216 | Cite as

The Impact of a Brief Motivational Intervention on Unprotected Sex and Sex While High Among Drug-Positive Emergency Department Patients Who Receive STI/HIV VC/T and Drug Treatment Referral as Standard of Care

  • Edward BernsteinEmail author
  • Desiree Ashong
  • Timothy Heeren
  • Michael Winter
  • Caleb Bliss
  • Guillermo Madico
  • Judith Bernstein
Original Paper


This randomized, controlled trial, conducted among out-of-treatment heroin/cocaine users at an emergency department visit, tests the impact on sexual risk of adding brief motivational intervention (B-MI) to point-of-service testing, counseling and drug treatment referral. 1,030 enrollees aged 18–54 received either voluntary counseling/testing (VC/T) with drug treatment referral, or VC/T, referral, and B-MI, delivered by an outreach worker. We measured number and proportion of non-protected sex acts (last 30 days) at 6 and 12 months (n = 802). At baseline, 70% of past-30-days sex acts were non-protected; 35% of sex acts occurred while high; 64% of sexual acts involved main, 24% casual and 12% transactional sex partners; 1.7% tested positive for an STI, and 8.8% for HIV. At six or 12 month follow-up, 20 enrollees tested positive for Chlamydia and/or Gonorrhea, and 6 enrollees HIV sero-converted. Self-reported high-risk behaviors declined in both groups with no significant between-group differences in behaviors or STI/HIV incidence.


HIV Emergency department Brief motivational intervention Sexual behavior risk 



Supriya Mehta, PhD was instrumental in the development of this proposal, but left Boston University for employment elsewhere shortly after the study began. We thank the patients for their participation in this study. The study was supported by a grant from the National Institute of Drug Abuse, NIH; RO1 DA017061. We acknowledge the dedicated contributions of Study Coordinators Ann Valentine, MPH, Desire Ashong, MPH, and Whitney Holmer, MD, Follow-up Coordinator Belinda Gilmere, and Research Assistants Michael Aguiar, Manuel Andrade, William Atherton, Jephthe Barthe, Ruben Codero, Jasmine Cromwell, Michelson Dorime, Helen Fassil, Darius Franklin, Richard Frazier, Suzanne Garverich, Robin Goffigan, Gregory Hastings, Judy Headley, Robert Johnson, Nicolasa Lopez, Yvonne Martinez, Jamilah Kim Mason, Virginia Mojica, Allison Molenda, Esosa Ogboghodo, Melissa Rambaud, Miguel Risco, Raymond Rodriguez, Devorath Ruiz, Stephanie Stapleton, Pamela Talbert, Kathy Vazquez, and Ebonie Woolcock, MD. Drs. Anita Raj and Katherine Tassiopoulos generously provided comments and suggestions.

Supplementary material

10461_2012_134_MOESM1_ESM.docx (91 kb)
Supplementary material 1 (DOCX 92 kb)


  1. 1.
    Jarlais DCD, Semaan S. HIV prevention and psychoactive drug use a research agenda. J Epidemiol Community Health. 2009;63:191–6.PubMedCrossRefGoogle Scholar
  2. 2.
  3. 3.
    Copenhaver MM, Johnson BT, Lee IC, Harman JJ, SHARP Research Team. Behavioral HIV risk reduction among people who inject drugs: meta-analytic evidence of efficacy. J Subst Abuse Treat. 2006;31(2):163–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Wechsberg WM, Lam WK, Zule WA, Bobashev G. Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers. Am J Public Health. 2004;94(7):1165–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Sterk CE, Theall KP, Elifson KW. Effectiveness of a risk reduction intervention among African American women who use crack cocaine. AIDS Educ Prev. 2003;15(1):15–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Meader N, Li R, Des Jarlais DC, Pillings S. Psychosocial intervention for reducing injection and sexual risk behavior for preventing HIV in drug users. The Cochrane Database of Systematic Reviews. 2010; Issue 1. art. No. CD007192. doi: 10.1002/14651858.CD007192.pub2.
  7. 7.
    Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark WH. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alc Depend. 2009;99:280–95.CrossRefGoogle Scholar
  8. 8.
    Vasilaki EI, Hosier SG, Cox WM. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol Alcohol. 2006;41(3):328–35.PubMedGoogle Scholar
  9. 9.
    Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction. 2001;96:1725–42.PubMedCrossRefGoogle Scholar
  10. 10.
    West DS, DiLillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care. 2007;30:1081–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooperman NA, Arnsten JH. Motivational interviewing for improving adherence to antiretroviral medications. Curr HIV/AIDS Rep. 2005;2(4):159–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Greaves CJ, Middlebrooke A, O’Loughlin L, Holland S, et al. Motivational interviewing for modifying diabetic risk: a randomized control trial. Br J Gen Pract. 2008; 535–40.Google Scholar
  13. 13.
    Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alc Depend. 2005;77:49–59.CrossRefGoogle Scholar
  14. 14.
    Bernstein E, Bernstein J, Levenson S. Project ASSERT: an ED based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med. 1997;30:181–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Bernstein E, Edwards E, Bliss C, Heeren T, Bernstein J. Screening and brief intervention to reduce Marijuana use among youth and young adults in a pediatric emergency department. Acad Emerg Med. 2009;16:1174–85.PubMedCrossRefGoogle Scholar
  16. 16.
    Skinner HA. The drug abuse screening test (DAST-10): guidelines for administration and scoring. Toronto: Addiction Research Foundation; 1995.Google Scholar
  17. 17.
    Ruggiero KJ, DelBen K, Scotti JR, Rabalais AF. Psychometric properties of the PTSD Checklist-Civilian version. J Traum Stress. 2003;16:495–502.CrossRefGoogle Scholar
  18. 18.
    Sobell LC, Sobell MB. Timeline followback user’s guide: a calendar method for assessing alcohol and drug use. Toronto: Addiction Research Foundation; 1996.Google Scholar
  19. 19.
    Midanik LT, Hines AM, Barrett DC, Paul JP, Crosby GM, Stall RD. Self-reports of alcohol use, drug use and sexual behavior: expanding the timeline follow-back technique. J Stud Alcohol. 1998;59:681–9.PubMedGoogle Scholar
  20. 20.
    Carey MP, Carey KB, Maisto SA, Gordon CM, Weinhardt LS. Assessing sexual risk behavior with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients. Int J STD AIDS. 2001;12(6):365–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Miller WR. Enhancing motivation for change in substance abuse treatment: treatment improvement protocol (TIP) series DHHS: publication no 99–3354. Rockville: Department of Health and Human Services; 1999.Google Scholar
  22. 22.
    Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. 2nd ed. New York: Guilford Press; 2002.Google Scholar
  23. 23.
    Bandura A. Self-efficacy: toward a unifying theory of behavior change. Psychol Rev. 1977;84:191–215.PubMedCrossRefGoogle Scholar
  24. 24.
    Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Velicer WF, DiClemente CC, Prochaska JO, Brandenberg N. A decisional balance measure for assessing and predicting smoking status. J Pers Soc Psychol. 1985;48:1279–89.PubMedCrossRefGoogle Scholar
  26. 26.
    Zuniga R, Cartier J, Anglin MD, Danila B, Ryan R, Mantius K. Staying in touch: a fieldwork manual of tracking procedures for locating substance abusers in follow-up studies. 2nd ed. Los Angeles: UCLA Integrated Substance Abuse Programs; 2003.Google Scholar
  27. 27.
    Woolard RH, Carty K, Wirtz P, et al. Research fundamentals: follow-up of subjects in clinical trials: addressing subject attrition. Acad Emerg Med. 2004;11:859–66.PubMedCrossRefGoogle Scholar
  28. 28.
    Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. 2006;55(RR-14):1–17.PubMedGoogle Scholar
  29. 29.
    Semaan S, Jarlais DCD, Malow R. Behavior change and health-related interventions for heterosexual risk reduction among drug users. Subst Use Misuse. 2006;41(10–12):1349–78.PubMedCrossRefGoogle Scholar
  30. 30.
    Semaan S, Jarlais DCD, Sokolow E, et al. A Meta-analysis of the Effect of HIV prevention interventions on the sex behaviors of drug users in the United States. J Acquir Imm Defic Synd. 2002;30:S73–93.Google Scholar
  31. 31.
    Calsyn DA, Crits-Christoph P, Hatch-Maillette MA, Doyle SR, Song YS, Coyer S, Pelta S. Reducing sex under the influence of drugs or alcohol for patients in substance abuse treatment. Addiction. 2010;105(1):100–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Bernstein J, Bernstein E, Heeren TC, Bernstein E. Mechanisms of change in control group drinking in clinical trials of brief alcohol intervention: implications for bias toward the null. Drug Alcohol Rev. 2010;29(5):498–507.PubMedCrossRefGoogle Scholar
  33. 33.
    Sterk CE, Elifson KW, Theall KP. Individual action and community context: the health intervention project. Am J Prev Med. 2007;32(6S):S177–81.PubMedCrossRefGoogle Scholar
  34. 34.
    Liebshutz JM, Finley EP, Braslin PG, Christiansen D, Horton NJ, Samet JH. Screening for sexually transmitted infections in substance abuse treatment programs. Drug Alc Depend. 2003;70:93–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Edward Bernstein
    • 1
    • 2
    Email author
  • Desiree Ashong
    • 1
    • 2
  • Timothy Heeren
    • 3
  • Michael Winter
    • 4
  • Caleb Bliss
    • 4
  • Guillermo Madico
    • 5
  • Judith Bernstein
    • 6
    • 7
  1. 1.Department of Emergency MedicineBoston University School of Medicine, Boston Medical CenterBostonUSA
  2. 2.Department of Community Health SciencesBoston University School of Public HealthBostonUSA
  3. 3.Department of BiostatisticsBoston University School of Public HealthBostonUSA
  4. 4.The Data Coordinating CenterBoston University School of Public HealthBostonUSA
  5. 5.Department of Infectious DiseaseBoston University School of MedicineBostonUSA
  6. 6.Department of Community Health SciencesBoston University School of Public HealthBostonUSA
  7. 7.Department of Emergency MedicineBoston University School of MedicineBostonUSA

Personalised recommendations