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).