Referee 1's review:

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N.B. These are the comments made by the referee when reviewing an earlier version of this paper. Prior to publication the manuscript has been revised in light of these comments and to address other editorial requirements.
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This is a clearly written report describing outcomes from a computer-based intervention aimed at reducing risk behaviors among HIV-positive clinic patients. This is an innovative program with potential applicability in a wide range of settings and should be of interest to HIV behavioral researchers and clinicians. The authors are to be commended. What follows are recommendations for improvement of this manuscript.

The authors may want to update and include a few more key articles in their literature review on the topic of "prevention with positives." The following are a few examples which include two meta-analytic reviews and a recent successful sexual risk behavior intervention with a large and diverse sample of HIV-positive people.

Johnson BT, Carey MP, Chaudoir SR, Reid AE. Sexual risk reduction for persons living with HIV: research synthesis of randomized controlled trials, 1993 to 2004. J Acquir Immune Defic Syndr. 2006 Apr 15;41(5):642-50.

Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S23-35.

Healthy Living Project Team. Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: the healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007 Feb 1;44(2):213-21.

In Methods, the authors need to provide more detail on recruitment procedures. Exactly how, when, and where were patients approached? When was eligibility determined (when and how did screening take place)? What was the refusal rate and who were the refusers? Did participants need to make appointments to conduct assessments or was it part of normally scheduled clinic visits? How were assessments and intervention participation coordinated with ongoing care over time? It's not clear how events unfolded for the study participants. And at the top of page 9, it says "Upon completion of the risk assessment, the Positive Choice program seamlessly transitioned ..." Please elaborate on how the transition was "seamless."

High retention rates are reported (which is good). Can the authors provide any information on how these rates compare to clinic retention. Were participants lost to follow-up for the study also lost to follow-up in the clinic? Were there participants who returned for clinic appointments but did not want to continue in the study?

In Methods we are told that HIV status of participants' partners was assessed, but it is not clear if these data were used to determine risk eligibility. And it is not reported in the Results as to whether there was any change in sex behaviors with serodiscordant vs seroconcordant partners. HIV transmission risk (i.e., unprotected sex with HIV-negative or unknown status partners) needs to be considered in the analyses and provided in the reporting of study outcomes.

Can any information be provided on the 25% of Cueing-Sheets that were not used in the medical appointments? (Why were they not used?)

Any outcomes of process evaluation would enhance this report. Can anything be said about patient and provider's experiences in this study and feelings about the intervention?

It seems to this reviewer that the claims made in the Discussion of the paper are a bit "over-stated." For example, on page 14 it says, "The Positive Choice program successfully overcame providers' traditional barriers to consistent risk screening and counseling ..." How was this determined? Results are not provided in the paper for the authors to make this claim. Related to this, the authors should elaborate on what they are saying in the very next sentence ("Because health risk information was shared ..."). It would be useful for the reader to know more about how provider-patient interactions really occurred in the study and how the approach could realistically be adapted for other clinical settings. These same comments (about over-stating outcomes) apply to the last paragraph of the paper, particularly the comment about not creating "additional burdens." Authors' claims may be true but need further elaboration and supportive evidence if they are to be made.

And in the next to last paragraph of the Discussion, the authors are a little too dismissive of the limitations that they themselves note. Can any additional information be provided in this paper about the potential for differential reporting of risk when patients know that their responses will be shared with the provider they are about to see? And while there may not be data on "sero-sorting" or "strategic positioning" per se, what were the outcomes when examining risk behaviors by partner status? What really was the impact of this intervention on transmission risk behaviors, especially since "absolute risk behavior declined over time for all participants?" Whatever the true outcomes were, this is a strong and interesting study (and report). There is no need to over-state intervention impact. It would be more useful to the field if the authors would grapple a bit more with the modest effects and the challenges of HIV risk behavior change studies. Finally, the authors may want to speculate about there having been significant intervention effects on illicit drug use, but not alcohol use.