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.
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.
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 Introduction A number of cohort studies provide evidence that gay men in large-city AIDS (acquired immunodeficiency syndrome) epicenters have substantially modified behavior patterns to reduce risk for HIV (human immunodeficiency virus) infection. [1][2][3][4][5] Recent studies suggest that fewer than 20 percent of gay men in New York City and under 10 percent of gay men in San Francisco have engaged in unprotected anal intercourse during the past 12 months.67 As a result, the prevalence of HIV infection among these populations has essentially reached a plateau, although at very high saturation levels.8,9Less is known about the risk behavior patterns of homosexual men in smaller cities where HIV infection prevalence is still relatively low. For AIDS primary prevention efforts to be successful in these areas, there must be a rapid shift in sexual behavior norms and practices comparable to those already achieved by most gay men in AIDS epicenters. Limited research to date suggests that has not occurred. [10][11][12] The current study examined AIDS risk knowledge, perceived sexual behavior norms, and risk behavior patterns in a sample of homosexual men in small cities with currently low prevalence of AIDS.
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