EXPLORE

Research Question

Does participating in an intensive counseling program help people protect themselves against HIV and other sexually transmitted diseases?

Study Design

Explore was a nationwide HIV prevention behavioral trial involving nearly 4,300 men who have sex with men. It was one of the largest behavioral studies of its kind and included participants from six cities: New York, Boston, Chicago, Denver, San Francisco and Seattle.

The study, which lasted three years, concluded on July 31, 2003 and the results were published in the July 3, 2004 issue of the Lancet. In San Francisco, we recruited 735 men.

Participants in Explore were randomly assigned to one of two arms of the study. Men in the control arm received standard HIV testing and counseling every six months. Men in the intensive counseling arm met with a counselor ten times over the course of 12 weeks for a structured yet individualized set of conversations.

These intensive counseling sessions were designed to help participants consider their own sexual choices and reflect on the situations that trigger them to be more or less safe. The people in this second group met with their counselors periodically for "booster" sessions during the rest of the study.

People in both study arms were regularly interviewed about their behaviors and received HIV and STD testing.

 

Study Results

Men in the intensive counseling group had more significant reductions in risk behavior than men in the control group. However, there was no significant difference in HIV infection rates by the end of the study between the two groups. This may have been because risk also declined in the control group, or because the counseling was unable to reduce risk enough over the 4 years of follow-up.

Lessons Learned

Data from this study is still be analyzed and we will continue to learn lessons from it. What we do know is that HIV counseling is an important part of HIV prevention efforts, including biomedical prevention strategies like HIV vaccines or pre-exposure prophylaxis.

The EXPLORE study provided important information about current factors that put men at risk for becoming infected, and will help in the design of better interventions for the future.

Major articles published about this study include the following:

Koblin B, Husnik M, Colfax G, Huang Y, Madison M, Mayer K, Barresi P, Coates T, Chesney M, Buchbinder S. Risk Factors for HIV infection Among Men who have Sex with Men. AIDS, 2006, 20: 731-739

Colfax G, Coates T, Husnik M, Huang E, Buchbinder S, Koblin B, Chesney M, Vittinghoff E. Longitudinal patterns of methamphetamine, popper, and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. J Urban Health. 2005 Mar;82(1 Suppl 1):62-70.

Chin-Hong PV, Vittinghoff E, Buchbinder S, Cohen D, Colfax G, Da Costa M, Darragh T, Hess E, Judson F, Koblin B, Madison M, Palefsky JM. Age-Specific Prevalence of Anal Human Papillomavirus Infection in HIV-Negative Sexually Active Men Who Have Sex with Men: The EXPLORE Study. JID, December 2004, 190(12):2070-6.

EXPLORE Study Team (Masthead article). Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomized control study. Lancet, July 2004, 364(9428):41-50.

Colfax G, Vittinghoff E, Husnik M, McKirnan D, Buchbinder S, Koblin B, Celum C, Chesney M, Huang Y, Mayer K, Bozeman S, Judson FN, Bryant K, Coates TJ. Substance use and sexual risk: A participant and episode-level analysis, among a cohort of men who have sex with men (MSM). Am J Epidemiology. 2004 May 15;159(10):1002-12.

Chesney M, Koblin B, Barresi P, Husnik M, Celum C, Colfax G, Mayer K, McKirnan D, Judson F, Huang Y, Coates T. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE study. American Journal of Public Health, 2003, 93 (6):933-938.