Brasfield Tl

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.

Factors influencing condom use among African American women : Implications for risk reduction interventions'

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.

Factor Structure and Validation of an Adolescent Version of the Condom Attitude Scale: An Instrument for Measuring Adolescents' Attitudes Toward Condoms.

Because of the absence of measures for use with adolescents the Condom Attitude Scale (CAS) was modified and its psychometric characteristics evaluated in a series of programmatic studies. Adolescent focus groups in study one examined the items and recommended changes in language. The number of items in the original CAS was therefore reduced from 57 to 35 and the scale was revised to a lower reading level. The modified 35-item version (CAS-35) was then pilot tested with a sample of 195 adolescents and achieved a Cronbachs alpha of 0.88 suggesting the need for further development. In study two the CAS-35 was administered to 312 African-American adolescents with convergent validity assessed against self-reported frequencies of condom use unprotected intercourse and treatment for sexually transmitted diseases. Psychometric properties of the instrument were evaluated with item analysis factor analysis and reliability estimation. The scale was subsequently refined to 23 items with a full scale Cronbachs alpha of 0.80 and six subscales with internal consistencies in the range 0.59-0.73. In study three 88 African-American adolescents completed the revised measure at an one-month interval to assess temporal stability and the instrument achieved a test-retest reliability of 0.84. In study four a cross validation sample of predominantly white adolescents (52) completed the 23-item version of the measure to determine whether its psychometric properties and factor structure originally established with the African-American adolescents replicated in a more heterogenous adolescent sample would hold up. Its criterion and convergent validity were evaluated against paper-and-paper measures assessing AIDS knowledge attitudes toward prevention and health locus of control. The final instrument (CAS-A) is brief easily administered assesses adolescents attitudes towards condoms and may be of interest to researchers investigating adolescent sexual behavior teen pregnancy and HIV or STD prevention.

Community-based interventions to reduce low income, African American women's risk of sexually transmitted diseases: a randomized controlled trial of three theoretical models.

A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.

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.

Cross-cultural comparison of US and Nigerian adolescents' HIV-related knowledge, attitudes, and risk behaviour: implications for risk reduction interventions.

Attitudes towards AIDS prevention, AIDS-related knowledge, and sexual behaviour of Nigerian adolescents and their African-American counterparts in two geographic regions of the United States were compared to assess cross-cultural similarities and differences between the adolescents. This study was conducted as the first in a programmatic sequence of activities leading toward the adaptation of a risk reduction intervention that was developed in the US for implementation with Nigerian youths. Subjects (n = 511) completed self-report measures of AIDS-related knowledge, attitudes towards condoms, attitudes towards AIDS prevention, sexual behaviour over the past two months, self- and response efficacy, and perceived vulnerability. Between-group comparisons revealed that US adolescents were more knowledgeable, held more favourable attitudes towards prevention and toward condoms, reported more sex partners, engaged in higher frequencies of unprotected vaginal intercourse, and became sexually active at later age than Nigerian adolescents. The findings are discussed with respect to their implications for translating risk reduction interventions developed in the US for African-American adolescents for later cross-cultural implementation with adolescents in developing countries where such risk reduction efforts are urgently needed.

Theoretical Models Applied to AIDS Prevention

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) offer an unprecedented challenge to psychologists. When researchers first identified the underlying cause of the epidemic as a retrovirus, it was apparent that behavior change would be the only means of curtailing HIV infection for literally years into the future while biomedical research searched for a vaccine or cure. AIDS is now well into its second decade, and behavioral methods remain the cornerstone of prevention efforts. Because of the retrovirus’s complex properties, biomedical solutions are slow to emerge and behavioral prevention remains at the forefront of efforts to interrupt the escalating spread of HIV infection and AIDS. For the first time in recorded history, psychologists, rather than biomedical professionals, are the key response to an epidemic. Psychologists can respond through behavior-change interventions on an individual, group, or community level; by altering the social stigma attached to these diseases through attitude-change programs; and by consultation with health educators, health-care providers, public health specialists, and policy-making bodies to aid in translating the scientific database into sound programs and policies.