This study examined whether active prompting would increase the number of free condoms taken from dispensers placed in counselors' offices in a cocaine abuse treatment clinic. Using a combined multiple baseline and reversal design, two teams of counselors were instructed to actively prompt and encourage condom taking during some conditions and to avoid commenting on or encouraging condom use in other conditions. To monitor accuracy of implementing the intervention, counselors completed a checklist for every subject they saw in their office during the day. Overall, the number of condoms taken per visit during prompting conditions was almost six times greater than during baseline conditions. However, implementation declined during the study, and all counselors complained about the intervention. Implications for dispensing free condoms to reduce HIV risk in drug abuse treatment clinics are discussed.
PIP: HIV infection is increasing among noninjecting as well as iv drug users. Of particular concern, are users of cocaine and crack cocaine, who are likely to trade sex for money or drugs and to have multiple sexual partners. This study investigated whether an active counselor intervention could increase the number of free condoms taken from dispensers placed in counselors' offices in a cocaine abuse treatment program in Philadelphia, Pennsylvania (US). A multiple baseline design across 2 teams of counselors with reversals was utilized. During the initial 5-week baseline period, when condoms were displayed on the counselors' desks but no prompts were given, an average of 0.34 and 0.25 condoms were taken per visit per team. During weeks 6-13, when counseling Team 1 utilized prompting and encouraged condom taking, this average increased to 3.17/visit. When Team 2 implemented the intervention (weeks 13-20), an average of 2.78 condoms/visit were taken. When both teams stopped the intervention, the number of condoms taken fell close to baseline levels. Resumption of the intervention increased use, but not to the previous high level. Over the entire 28-week study period, clients took an average of 0.43 condoms/visit during baseline conditions, and 2.45/visit during counselor prompting conditions. The 6-fold increase in condom uptake associated with active encouragement suggests the feasibility of this strategy for cocaine treatment programs. However, the participating counselors voiced irritation with the mandatory, sometimes intrusive intervention. The availability of free condoms in the clinic waiting area or day room represents an alternative strategy documented to increase the taking of condoms.