The influence of psychosocial difficulties on women's attrition in an HIV/STD prevention program.

We examined attrition from an HIV/STD group counselling intervention in two ways: quantitative analyses of the entire sample (n=287) and structured interviews of a subset of 30 women with low attendance. In the interviews, the most common reasons for low attendance were time conflicts and enrolling primarily to obtain the monetary incentives given for completing research questionnaires. Latent class statistical analysis of the full sample identified two subgroups that differed from each other in the number of psychosocial problems recently experienced. Relative to the 'non-distressed' class, the 'distressed' class members had higher probabilities of psychological distress, low incomes, heavy substance use, sex for trade, relationship violence, and unstable housing. This group had higher HIV/STD risk, but lower intervention attendance. Members also had less education and less knowledge about HIV/STD. A higher proportion of the distressed group was African-American. Study findings suggest that in interventions for women at HIV/STD risk, it is not necessarily enough to ensure cultural relevance and to provide food, childcare, and transportation. To increase retention, interventionists should consider (1) the use of strategies to support attendance (such as monetary incentives and attention to group process factors) and (2) intervention formats that are brief, matched to participants' stage of change, population-specific, and/or maximally accessible.

Relapse prevention as an interventive model for HIV risk reduction in gay and bisexual men.

Despite considerable self-initiated HIV risk reduction among men who have sex with men, little is known about how to design interventions that will effectively assist individuals from this population in maintaining safer sex behaviors over time. The present study evaluated the effectiveness of a 17-session group counseling intervention that incorporated components based on a cognitive-behavioral model of relapse. Differential behavioral outcomes following treatment included an increase in the percentage of sexual activities that were protected and a decrease in unprotected oral sex. However, considerable risk reduction (e.g., increased condom use, decreased unprotected sex, and decreases in the number of male partners and in the total number of sexual acts) occurred in both treated and untreated participants. Measures of mediating attitudinal variables drawn from relapse prevention theory largely predicted behavioral changes. Over time, several of the risk reduction behaviors achieved at posttreatment were not maintained, suggesting the importance of further developing effective strategies for supporting behavior change maintenance.

Perinatal risk screening and infant outcome. Can predictions be improved with composite scales?

This study extended earlier research by identifying the specific items in the pool of items from five existing perinatal risk scales that correlate with specific infant outcome measures. Predictive items obtained from analyses of one sample of subjects were used to predict outcomes in two other samples, one drawn retrospectively and the other, prospectively. The result was an improvement over most existing perinatal risk scales in the ability to predict a greater number of outcome measures. Improvements in the amount of variance accounted for by the composite scales remain to be made.