Behavioral intervention to reduce AIDS risk activities.

Behavior change can curtail the spread of acquired immune deficiency syndrome (AIDS). In this study, 104 gay men with a history of frequent AIDS high-risk behavior completed self-report, self-monitoring, and behavioral measures related to AIDS risk. The sample was randomly divided into experimental and waiting-list control groups. The experimental intervention provided AIDS risk education, cognitive-behavioral self-management training, sexual assertion training, and attention to the development of steady and self-affirming social supports. Experimental group participants greatly reduced their frequency of high-risk sexual practices and increased behavioral skills for refusing sexual coercions, AIDS risk knowledge, and adoption of "safer sex" practices. Change was maintained at the 8-month follow-up.

Psychological factors that predict AIDS high-risk versus AIDS precautionary behavior.

Men (N = 526) who patronized gay bars in three cities completed measures of sexual behavior covering the previous 3 months and psychological measures theoretically pertinent to AIDS risk. Thirty-seven percent of the sample reported engaging in unprotected anal intercourse, the behavior most strongly associated with transmission of human immunodeficiency virus (HIV) infection. Perceived peer norms concerning the acceptability of safer sex practices, AIDS health locus of control scores, risk behavior knowledge, age, and accuracy of personal risk estimation, but not personal HIV serostatus knowledge, were associated with high-risk and precaution-taking behavior.

A skills-training group intervention model to assist persons in reducing risk behaviors for HIV infection.

Fifteen gay men with a history of recent high-risk sexual activities attended seven group sessions that provided risk education, training in self-management skills pertinent to risk reduction, sexual assertiveness training, and problem solving with respect to health consciousness, social supports, and efficacy of risk-reduction change. Before and after intervention, subjects completed measures of AIDS risk knowledge, sexual practices occurring over 4-month retrospective periods, and self-monitored records of ongoing sexual activities and participated in role plays assessing behavioral assertiveness skill for resisting high-risk coercions. Eight-month follow-up data were also collected. Subjects exhibited substantial and well-maintained change following intervention in behaviors relevant to HIV infection risk, including frequency of unprotected anal intercourse (which decreased to near-zero levels), condom use (which increased to almost 90% of intercourse occasions), and in an index that reflects the multiplicative function of risk behaviors frequency by the number of partners with whom high-risk behaviors occurs. This demonstration provides further evidence that skills-training approaches can assist individuals in implementing behavior changes to reduce risk for AIDS and identifies a model relevant to counseling efforts in AIDS prevention programs, HIV counseling and testing programs, drug abuse and STD clinics, and other applied settings.

Differences in gay men's AIDS risk knowledge and behavior patterns in high and low AIDS prevalence cities.

Several studies have found reductions in acquired immunodeficiency syndrome (AIDS) risk practices among gay men in high AIDS-prevalence cities since the start of the AIDS crisis. Much less is known about risk behavior patterns among gay men in smaller cities, where AIDS cases are less common and the prevalence of human immunodeficiency virus infection is relatively lower. In the study, men entering gay bars in three cities, one large and two small, completed anonymous surveys of sexual practices and AIDS risk knowledge. Men in high AIDS-prevalence areas were found to have had a greater number of sexual partners, were more knowledgeable about AIDS, were much more likely to engage in low-risk practices (such as mutual masturbation or body rubbing), and had unprotected anal intercourse less frequently than gay men in smaller cities. The most common sexual activity among gay men in the larger city was mutual masturbation, a low-risk practice. The most common sexual activity among gay men in the smaller cities was unprotected anal intercourse. Increased efforts are needed to educate gay men and to promote risk behavior changes among those living in smaller cities and in communities outside the prominent AIDS epicenters.

An objective test of AIDS risk behavior knowledge: scale development, validation, and norms.

Efforts to curtail the spread of AIDS emphasize changing risk practices. An objective measure of practical knowledge about AIDS risk behaviors can permit the more accurate assessment of the impact of such prevention programs. This paper describes the construction of a standardized 40-item test of AIDS risk behavior knowledge and presents data on the validity, reliability, and psychometric characteristics of the measure in addition to norms for several populations. Knowledge scores of risk behavior may serve as a useful dependent measure when evaluating the impact of applied or experimental AIDS prevention programs, especially with groups at potential risk for the syndrome.

The stigma of AIDS: fear of disease and prejudice toward gay men.

Three hundred college students were presented with vignettes describing an ill person; the vignettes were identical except the illness was identified as either AIDS or leukemia and the individual was described as either homosexual or heterosexual. After reading one vignette, each subject completed a set of measures sensitive to interpersonal evaluation, prejudicial attitudes, and willingness to interact casually with the portrayed individual. The findings indicate the presence of highly stigmatizing attitudes towards AIDS patients and suggest that the public views AIDS patients and gay persons with similar attitudinal prejudice. The need for greater attention to AIDS by social and behavioral researchers is discussed.

Stigmatization of AIDS patients by physicians.

A randomly selected sample of physicians in three large cities was asked to read one of four vignettes describing a patient. They then completed a set of objective attitude measures eliciting their reactions to the patient described in the vignette. The vignettes were identical except that the patient's illness was identified as either acquired immunodeficiency syndrome (AIDS) or leukemia and the patient's sexual preference as either heterosexual or homosexual. Harsh attitude judgements were associated with the AIDS portrayals, as well as much less willingness to interact even in routine conversation when the patient's illness was identified as AIDS. Increasing numbers of AIDS patients will be seeking medical attention from physicians in all areas of the country and it will be important for health care professions to develop programs which counter unreasonable stigma and prejudicial attitudes that may be associated with this illness.

Medical students' attitudes toward AIDS and homosexual patients.

More than most diseases, acquired immune deficiency syndrome (AIDS) appears to elicit highly negative, fearful, and prejudicial attitudes. In the study reported here, medical students read one of four patient vignettes. The vignettes were identical in content except that the patient was identified as having either AIDS or leukemia as either homosexual or heterosexual. The students then completed a set of objective measures that assessed their attitudes toward the patient portrayed in the vignette. Multivariate and univariate analyses of variance of their responses revealed that the students held negative and prejudiced attitudes toward both the AIDS and homosexual patients. This finding suggests that medical educators should recognize that many students have stigmatizing, negative attitudes toward homosexuals and patients with AIDS. These educators should promote greater sensitivity, knowledge, and understanding among medical students of those at risk for AIDS and AIDS patients.

Situational factors associated with AIDS risk behavior lapses and coping strategies used by gay men who successfully avoid lapses.

While most gay men have reduced behavior practices at high risk for HIV infection, there is growing evidence that many also lapse to unsafe sex. This study examined situational factors related to risk behavior lapses as well as coping strategies used by men who successfully resist lapse urges. A convenience sample of 470 men patronizing gay bars or attending social organization meetings in four cities was surveyed. Forty-five percent of men were classified as "lapsers" (those who had had unprotected anal intercourse in the previous 6 months) and 24% were classified as "resisters" (those who successfully resisted urges to engage in this behavior). All provided information concerning the importance of factors related to the most recent occurrence of either unsafe sex or resisting unsafe urges. Most episodes of unsafe sex occurred outside monogamous relationships and with partners of unknown HIV serostatus, although simply inquiring about partner serostatus was relatively common. Lapsers rated affectionate feelings and wishing to please a partner as well as spontaneity of unsafe sex as the most important situational factors surrounding high-risk behavior. Resisters of unsafe sex urges reported active cognitive self-guidance, experience in safe sex, and recall of both AIDS fears and safety benefits as their most important coping strategies. Gay men who continue high-risk behavior may be overrelying on partner reports of negative serostatus. Lapse prevention approaches tailored to situations that create increased risk vulnerability must be developed. Teaching skills already used by men who successfully resist unsafe sex urges might be one approach.