CLEAR: Choosing Life: Empowerment, Actions, Results
Prevention for HIV Positive Youth and Adults
At a glance:
|P.I.||Mary Jane Rotheram-Borus, Ph.D.|
|Current Contact||Dallas Swendeman|
|Population Served||Living with HIV, HIV Prevention|
Living with HIV
Choosing Life: Empowerment, Action, Results! (CLEAR) for Comprehensive Risk Counseling and Services (CRCS)
CLEAR-CRCS is an evidence based HIV prevention and health promotion intervention developed for people living with HIV enrolled in Comprehensive Risk Counseling and Services (CRCS). It is a client-centered program delivered one-on-one with clients who are having difficulty initiating or sustaining behaviors that prevent HIV transmission and reinfection. The program teaches clients cognitive-behavioral strategies to cope with triggers and other stressful situations that lead to risky behaviors and unhealthy choices. The goal of CLEAR-CRCS is to help these people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. CLEAR-CRCS is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.
CLEAR-CRCS is structured such that the CRCS provider can individually tailor the program to address the unique needs of each client. The program consists of six foundational sessions that teach the core behavioral strategies of the program. Within these initial sessions, the client also develops a personal life goal and his or her prevention plan which will direct the focus of subsequent sessions. The provider then has a menu of 21 sessions to choose from in which the client can practice and apply the core strategies to realize his or her goals. The sessions in the menu address five domains: sexual behavior, substance use, treatment adherence, mental health, and successful disclosures.
Research on the original CLEAR Intervention: The original CLEAR study was conducted from 1999-2003 with an ethnically and culturally diverse group of substance using young people living with HIV/AIDS. The intervention was conducted as a multi-site trial in Los Angeles, San Francisco, and New York. The study demonstrated a significant increase in protected sexual acts, such as using condoms, with all partners and with HIV-negative partners.
Underlying Theory and Principles: The intervention was developed based on the social action theory. Social action theory stresses the importance of social interactions and environmental factors in a person’s ability to control behaviors that may endanger his or her health. It incorporates the principles that are expressed in traditional social-cognitive models of health-behavior change, including social-cognitive theory, the health belief model, and the transtheoretical model (stages of change). CLEAR-CRCS is predicated on the notion that behavior change depends both on a person’s belief that he or she can change a behavior (self-efficacy) and the beliefs that changing the behavior will result in a desired outcome (response efficacy).
Original efficacy trial: Young People Living with HIV (YPLH) aged 16-29. In CDC dissemination through CRCS the target population also include high-risk HIV-negative persons and ages 16 or above (so not restricted to young adults).
Randomized Controlled Trial. Individuals randomly assigned to immediate intervention or a delayed (waitlisted) control group and completed assessment interviews every three months for 15 months.
Participants reduced substance use and sexual risk behaviors.
Individual level intervention
Original efficacy trial tested in-person delivery (more efficacious) and telephone delivery.
CURRENT Manuals from CDC funded work for DEBI:
Original RCT Protocol 1998-2002
- Module 1
- CLEAR- Mod 1, Sess 1: Identifying My Strengths: Creating A Vision for the Future. (1.5 hrs.) (1501)
- CLEAR- Mod 1, Sess 2: I'm HIV-Positive: Attitudes as Barriers to Future Goals. (1.5 hrs.) (1424)
- CLEAR- Mod 1, Sess 3: Making Commitments: Evaluating and Changing Substance Use. (1.5 hrs.) (1407)
- CLEAR- Mod 1, Sess 4: Seeing the Patterns: Why Do I Use Drugs and Alcohol? (1.5 hrs.) (1415)
- CLEAR- Mod 1, Sess 5: Beliefs: Thoughts That Influence My Substance Use Patterns. (1.5 hrs.) (1421)
- CLEAR- Mod 1, Sess 6: Future Goals: The Impact of Using Drugs and Alcohol. (1.5 hrs.) (1387)
- Module 2
- CLEAR- Mod 2, Sess 7: Higher Self and Sexual Decisions: Facing the Challenges. (1.5 hrs.) (1465)
- CLEAR- Mod 2, Sess 8: Higher Self and Sexual Decisions: Changing Risk Behaviors. (1.5 hrs.) (1416)
- CLEAR- Mod 2, Sess 9: Making Sexual Decisions: Having Safety and Pleasure. (1.5 hrs.) (1372)
- CLEAR- Mod 2, Sess 10: Making Sexual Decisions: Can I Use Condoms (Correctly)? (1.5 hrs.) (1495)
- CLEAR- Mod 2, Sess 11: Making Sexual Decisions: Can I Influence My Partner To Use Condoms? (1.5 hrs.) (1383)
- CLEAR- Mod 2, Sess 12: Making Sexual Decisions: How Do I Refuse Unprotected Sex? (1.5 hrs.) (1447)
- Module 3
- CLEAR- Mod 3, Sess 13: Motivation for Change: Wanting to Stay Healthy (1.5 hrs.) (1571)
- CLEAR- Mod 3, Sess 14: Attending Health Care Appointments (1.5 hrs.) (2125)
- CLEAR- Mod 3, Sess 15: Participating In Medical Care: Communication and Decision-making Skills (1.5 hrs.) (1409)
- CLEAR- Mod 3, Sess 16: Medication Schedules: Can I Stay on Track? (1.5 hrs.) (1429)
- CLEAR- Mod 3, Sess 17: Medication Schedules: More Tools to Stay on Track (1.5 hrs.) (1418)
- CLEAR- Mod 3, Sess 18: Maintaining My Progress: Focus on the Future. (1.5 hrs.) (1465)
- CLEAR Individual Workbook I (Prevention for HIV Positive Adult and Youths) (1584)
- CLEAR Individual Workbook II (Prevention for HIV Positive Adult and Youths) (1618)
- CLEAR Individual Workbook III (Prevention for HIV Positive Adult and Youths) (1455)
- CLEAR Telephone Conf Call Grp- Mod 1, Sess 1- Identifying My Strengths: Creating A Vision for the Future (1.5 hrs.) (1468)
- CLEAR Telephone Conf Call Grp- Mod 1, Sess 2- I’m HIV Positive: Attitudes as Barriers To Future Goals (1.5 hrs.) (1457)
- CLEAR Telephone Conf Call Grp- Mod 1, Sess 4- Beliefs: Thoughts That Influence My Substance Use Patterns (1.5 hrs.) (1347)
- CLEAR Telephone Conf Call Grp- Mod 1, Sess 5- Future Goals: The Impact of Using Drugs and Alcohol (1.5 hrs.) (1412)
- CLEAR Telephone Conf Call Grp- Mod 1, Sess 6- Making Commitments: Evaluating and Changing Substance Use (1.5 hrs.) (1512)
NOTE: The original randomized controlled trial had a telephone group format that was not feasible for youth at that time. Only the 1st module was completed, but it is in included here for reference. The activities can be adapted and used for more current interventions.
Surveys and Scales Used:
- Quality of Life, HIV (HAT - QoL) (2825)
- Medication Adherence (1697)
- Self Harm: Suicide History (1717)
- CDC Sexual Behavior Questions (CSBQ) (4737)
- School History (1528)
- Detention/Jail History (1584)
- Alcohol and Other Drug Abuse (AOD) (1930)
- Dealing with Illness (1626)
- Pregnancy History (1564)
- Medical Outcomes Study (MOS) Social Support Survey (4271)
- Life Outcome Expectancies (1654)
- Life Goals (1669)
- HIV Testing Questions - CDC (CHTQ) (2178)
- Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder (1743)
- Nutrition and Exercise (1647)
- Coming Out (1573)
- AHIMSA Acculturation, Habits, and Interests Multicultural Scale for Adolescents (2469)
- Sexually Transmitted Disease (2006)
- Sexual Abuse (1544)
- Post-Exposure Prevention (PEP) Behavior (1571)