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Changing Sexual Behavior Among Gay Male Repeat Testers for HIV: A Randomized, Controlled Trial of a Single-Session Intervention

Dilley James W.; Woods, William J.; Sabatino, James; Lihatsh, Tania; Adler, Barbara; Casey, Shannon; Rinaldi, Joanna; Brand, Richard; McFarland, Willi
JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2002
doi: 10.1097/01.QAI.0000016823.19906.41
Articles: PDF Only

Context:High-risk sexual behavior is increasingly prevalent among men who have sex with men (MSM) and among men with a history of repeat testing for HIV.

Objectives:The study assessed whether one counseling intervention session focusing on self-justifications (thoughts, attitudes, or beliefs that allow the participant to engage in high-risk sexual behaviors) at most recent unprotected anal intercourse (UAI) is effective in reducing future high-risk behaviors among HIV-negative men.

Design, Setting, and Participants:A randomized, controlled, counseling intervention trial was conducted at an anonymous testing site in San Francisco, California, between May 1997 and January 2000. Participants were 248 MSM with a history of at least one previous negative HIV test result and self-reported UAI (receptive or insertive) in the previous 12 months with partners of unknown or discordant HIV status. Two intervention groups received standard HIV test counseling plus a cognitivebehavioral intervention, and two control groups received only standard HIV test counseling. Follow-up evaluation was at 6 and 12 months.

Main Outcome Measure:Number of episodes of UAI with nonprimary partners (of unknown or discordant HIV status) in the 90 days preceding the interview was measured via self-report during face-to-face interview.

Results:A novel counseling intervention focusing on self-justifications significantly decreased the proportion of participants reporting UAI with nonprimary partners of unknown or discordant HIV status at 6 and 12 months (from 66% to 21% at 6 months and to 26% at 12 months, p = .002; p < .001) as compared with a control group when added to standard client-centered HIV counseling and testing.

Conclusions:A specific, single-session counseling intervention focusing on a reevaluation of a person's self-justifications operant during a recent occasion of high-risk behavior may prove useful in decreasing individual risk behavior and thus limiting community-level HIV transmission.

Address correspondence and reprint requests to James W. Dilley, Executive Director, UCSF AIDS Health Project, Box 0884, San Francisco, CA 94143-0884, U.S.A.; e-mail:

Manuscript received October 6, 2001; accepted February 28, 2002.

This research was supported by National Institute of Mental Health grant RO1-MH56263-03.

© 2002 Lippincott Williams & Wilkins, Inc.