Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities.

OBJECTIVES: It is critical to extend community-level acquired immunodeficiency syndrome (AIDS) prevention efforts beyond education alone and to develop models that better encourage behavioral changes. Gay men in small cities are vulnerable to human immunodeficiency virus (HIV) infection due to continued high rates of risk behavior. This research introduced an intervention that trained popular people to serve as behavioral change endorsers to peers sequentially across three different cities. METHODS: Populationwide surveys were conducted of all men patronizing gay clubs in each city to establish risk behavior base rates. After a small cadre of popular "trendsetters" were identified, they received training in approaches for peer education and then contracted to communicate risk reduction recommendations and endorsements to friends. Surveys were repeated at regular intervals in all cities, with the same intervention introduced in lagged fashion across each community. RESULTS: Intervention consistently produced systematic reductions in the population's high-risk behavior (unprotected anal intercourse) of 15% to 29% from baseline levels, with the same pattern of effects sequentially replicated in all three cities. CONCLUSIONS: This constitutes the first controlled, multiple-city test of an HIV prevention model targeting communities. The results support the utility of norm-changing approaches to reduce HIV risk behavior.

HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis.

BACKGROUND AND PURPOSE: Peer norms influence the adoption of behavior changes to reduce risk for HIV (human immunodeficiency virus) infection. By experimentally intervening at a community level to modify risk behavior norms, it may be possible to promote generalized reductions in HIV risk practices within a population. METHODS: We trained persons reliably identified as popular opinion leaders among gay men in a small city to serve as behavior change endorsers to their peers. The opinion leaders acquired social skills for making these endorsements and complied in talking frequently with friends and acquaintances. Before and after intervention, we conducted surveys of men patronizing gay clubs in the intervention city and in two matched comparison cities. RESULTS: In the intervention city, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent to 27.5 percent (-25 percent from baseline), with a reduction from 27.1 percent to 19.0 percent (-30 percent from baseline) for unprotected receptive anal intercourse. Relative to baseline levels, there was a 16 percent increase in condom use during anal intercourse and an 18 percent decrease in the proportion of men with more than one sexual partner. Little or no change was observed among men in the comparison cities over the same period of time. CONCLUSIONS: Interventions that employ peer leaders to endorse change may produce or accelerate population behavior changes to lessen risk for HIV infection.

AIDS-related training in U.S. schools of social work.

This article presents the results of a survey of 70 master of social work (MSW) programs to determine the extent and manner in which educational curricula include instruction on acquired immune deficiency syndrome (AIDS). Most programs offer students training in foundation areas pertinent to AIDS, including health and mental health systems, practice with racial and ethnic minorities, and substance abuse prevention and treatment. However, over 40 percent of programs provide no training in such key areas as human sexuality and primary prevention. Less than 15 percent of programs offer courses specific to AIDS, although a third of programs have incorporated AIDS content into other courses. Between 20 percent and 30 percent of MSW programs offer little or no attention to AIDS in their curricula. Implications of these findings are discussed.

AIDS risk behavior patterns among gay men in small southern cities.

Men entering gay bars in three small southern cities were administered questionnaires to assess AIDS (acquired immunodeficiency syndrome) risk knowledge, perceived norms concerning the social acceptability of AIDS risk precautions, and personal sexual behavior. Seventy-seven percent (N = 355) of male patrons completed the measures. While risk knowledge levels were high, respondents did not perceive strong norms favoring risk reduction precautions. Rates of risk behavior were considerably higher than those reported for gay men in large urban epicenters.