Motivational Interviewing Seeks Specific Solutions: Interventions Shift Responsibility to the Clients

A four-session HIV-prevention program for HIV-positive Latinos, called Positively Latino, has successfully adapted the theoretical model of motivational interviewing, a different approach than the traditional case-management model.

"Motivational interviewing allows the client to make a decision based on his or her own motivations,' said Deanna McPherson, MPH, CHES, capacity building coordinator for PROCEED Inc. in Elizabeth, N.J. "It's the interviewer's responsibility to try to find ways to motivate the client to try to make a change in risk behaviors." She said the approach works well with HIV-positive clients because it shifts responsibility for preventing HIV transmission to them without shifting blame for the epidemic.

The program, mostly conducted in Spanish, includes counseling, questionnaires, worksheets designed to focus the client on steps toward change and people who can assist them with making changes.

The first session, which lasts 90 minutes, includes a pre-test and obtaining the client's consent to videotape the session. A counselor discusses the client's motivation for change and emphasizes the change is ultimately the client's responsibility.

The second session is held one week later. In it, the counselor reiterates the ideas from the first session. S/he discusses the idea of a change plan and of developing a new one or updating an existing one.

During the third session, clients complete a second questionnaire that is more specific to drug and alcohol abuse and also asks about viral load and history with HIV drugs. This session reviews the two previous and assesses client progress and barriers to change.

The fourth session reviews the three previous and returns to the matter of change plans. Counselors then discuss sexual behaviors and condom use.

Counselors provide clients with referrals once they have completed the program.

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