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One-to-one counselling for STI prevention: not so much whether as how
  1. Helen Ward
  1. Correspondence to:
 Dr H Ward
 Department of Infectious Disease Epidemiology, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK; h.ward{at}

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The UK National Institute for Health and Clinical Excellence is about to recommend prevention counselling to reduce STI risk. A US paper in this issue reviews relevant evidence and looks at the challenges for implementation in busy clinics.

Few people would disagree with Geoffrey Rose’s justification for disease prevention: “It is better to be healthy than ill or dead”.1 In the field of sexually transmitted infections (STI) and HIV, preventive interventions have gone alongside treatment and care for as long as services have existed, but the priority given to each has varied over time.

In this issue (see page 2), Cornelis Rietmeijer reviews risk reduction counselling for STI, questioning the lack of implementation of interventions of proven efficacy.2 He looks particularly at the USA, where the Centers for Disease Control and Prevention (CDC) have advocated risk reduction counselling in relation to HIV testing services, but this has not always been carried out in practice.

Rietmeijer includes evidence in his review showing that in Project RESPECT, two brief one-to-one counselling sessions resulted in a 30% reduction in STI incidence at six months. In …

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