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

Abstract

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.

The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial

“…Also, perceived likelihood of infection was not associated with lower risk behaviors. The final finding was that, even though peer educators had been useful among non-runaways in significantly reducing the frequency of unprotected anal intercourse among men who have sex with men (Kelly et al 1992), this intervention was not effective in changing risk behaviors, especially sex behaviors among runaways. Analyses indicated that only runaways in the control condition reduced their sex risks over time.…”

Diffusion of Positive AIDS Care Messages Among Service Providers in China

“…Diffusion theory posits that behavioral change is achieved when information and ideas, such as new risk-reducing methods in the case of HIV prevention, is disseminated by opinion leaders through their personal and social networks (Sivaram et al, 2004). Kelly and colleagues have shown that systematically identified, recruited, and trained POLs make a positive impact on sexual behavior change in populations of men attending gay bars in the United States (Kelly et al, 1991;Kelly et al, 1992;Kelly et al, 1997). In the POL model, ethnographic techniques are employed to systematically identify popular and socially influential members of the target population.…”

Using qualitative methods within a mixed-methods approach to developing and evaluating interventions to address harmful alcohol use among young people.

“…It also employed two important aspects of peer education: using peers as opinions leaders and models in relation to moderate alcohol use (Kelly et al, 1992); and encouraging young people to think critically about their own behavior in a "binge drinking" youth culture (Campbell & MacPhaill, 2002).…”