HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis.
Open accessAbstract
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.
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Norms feedback interventions have been shown to reduce substance misuse and HIV risk behaviours separately.
“Norms feedback interventions have proven useful in reducing both substance misuse (Neville, 2015) and HIV risk behaviours (Kelly et al., 1991) separately”
From Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours? (2015) · cites this paper as Kelly et al., 1991
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MethodHIV/AIDS Education and Prevention Among African-Americans: A Focus on Culture
Airhihenbuwa, C. O., DiClemente, R. J., Wingood, G. M., & Lowe, A. (1992) · AIDS Education and Prevention · doi:10.1521/aeap.1992.4.3.267 · Cited by 127 · see citing works
Rotheram–Borus, M. J., Flannery, D., Rice, E. R. W., & Lester, P. E. (2005) · AIDS Care · doi:10.1080/09540120500101690 · Cited by 122 · see citing works
“Advantages such as broad access to condoms, screening and treatment for sexually transmitted diseases, and national awareness of the means of HIV transmission were present in the communities in which HIV interventions were designed, but were often unacknowledged in the description of interventions (Kelly et al, 1991 ;…”
BackgroundBurns, B. J., & Hoagwood, K. (2002) · doi:10.1093/acprof:oso/9780195134575.001.0001 · Cited by 281 · see citing works
Grov, C., Hirshfield, S., Remien, R. H., Humberstone, M., & Chiasson, M. A. (2011) · Archives of Sexual Behavior · doi:10.1007/s10508-011-9854-x · Cited by 119 · see citing works
Burchard, J. D., Bruns, E. J., & Burchard, S. N. (2002) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195134575.003.0004 · Cited by 117 · see citing works
A field experiment testing frontline opinion leaders as change agents.
Lam, S. S. K., & Schaubroeck, J. M. (2000) · Journal of Applied Psychology · doi:10.1037/0021-9010.85.6.987 · Cited by 118 · see citing works
BRYANT, K. J. (2006) · Substance Use & Misuse · doi:10.1080/10826080600846250 · Cited by 116 · see citing works
“The combination of alcohol setting and network characteristics has been effectively exploited to develop and implement effective interventions (Kelly et al., 1991; Latkin and Knowlton, 2005).”
BackgroundBorgia, P., Marinacci, C., Schifano, P., & Perucci, C. A. (2005) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2004.03.005 · Cited by 115 · see citing works
Young, L. E., Schumm, L. P., Alon, L., Bouris, A. M., Ferreira, M. J., Hill, B. J., Khanna, A. S., Valente, T. W., & Schneider, J. A. (2017) · Clinical Trials · doi:10.1177/1740774517730012 · Cited by 114 · see citing works
Psychological interventions with AIDS and HIV: Prevention and treatment.
Kelly, J. A., & Murphy, D. A. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.60.4.576 · Cited by 113 · see citing works
Self-citationReducing HIV-Related Stigma in Health Care Settings: A Randomized Controlled Trial in China
Li, L., Wu, Z., Liang, L.-J. F., Lin, C., Guan, J., Jia, M., Rou, K., & Yan, Z. (2012) · American Journal of Public Health · doi:10.2105/ajph.2012.300854 · Cited by 111 · see citing works
A Profitable Conjunction: From Science to Service in Children’s Mental Health
Hoagwood, K., Burns, B. J., & Weisz, J. R. (2002) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195134575.003.0014 · Cited by 110 · see citing works
Sex Hustling, Injection Drug Use, and Non-Gay Identification by Men Who Have Sex With Men
RIETMEIJER, C. A. M., Wolitski, R. J., Fishbein, M., Corby, N. H., & Cohn, D. L. (1998) · Sexually Transmitted Diseases · doi:10.1097/00007435-199808000-00006 · Cited by 110 · see citing works
BEHAVIORAL COMMUNITY INTERVENTION TO REDUCE THE RISK OF SKIN CANCER
Lombard, D. N., Neubauer, T. E., Canfield, D., & Winett, R. A. (1991) · Journal of Applied Behavior Analysis · doi:10.1901/jaba.1991.24-677 · Cited by 110 · see citing works
“Thus, peer leaders may be efficient multipliers of change efforts in a number of risk-reduction programs (Geller et al., 1990; Kelly et al., 1991).”
BackgroundInfluentialSexual Positioning Among Men Who Have Sex With Men: A Narrative Review
Dangerfield, D. T., Smith, L. R., Williams, J. E., Unger, J. B., & Bluthenthal, R. N. (2016) · Archives of Sexual Behavior · doi:10.1007/s10508-016-0738-y · Cited by 108 · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript explore these outcomes as a consequence of dynamic relational forces of masculinity, power dynamics, partner type, or HIV status (Jones et al., 2008; J A Kelly et al., 1991).”
BackgroundRice, E. R. W., Tulbert, E., Cederbaum, J. A., Adhikari, A. B., & Milburn, N. G. (2012) · Health Education Research · doi:10.1093/her/cyr113 · Cited by 107 · see citing works
“For all participants, dissemination of online media and the accompanying HIV prevention dialog utilized the Diffusion of Innovations [45], which has successfully been employed in face-to-face HIV prevention strategies [8, 57, 58].”
Method. HIV intervention research for men who have sex with men: a 7-year update.
Johnson, W. D., Holtgrave, D. R., McClellan, W. M., Flanders, W. D., Hill, A. N., & Goodman, M. (2005) · AIDS Education and Prevention · doi:10.1521/aeap.2005.17.6.568 · Cited by 105 · see citing works
Predictors of African American Adolescents' Condom Use and HIV Risk Behavior
Reitman, D. S., Lawrence, J. S. S., Jefferson, K. W., Alleyne, E., Brasfield, T. L., & Shirley, A. (1996) · AIDS Education and Prevention · doi:10.1521/aeap.1996.8.6.499 · Cited by 106 · see citing works
Self-citationMorrison, D. M., Gillmore, M. R., & Baker, S. A. (1995) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.1995.tb01767.x · Cited by 106 · see citing works
Amirkhanian, Y. A., Kelly, J. A., Kabakchieva, E., McAuliffe, T. L., & Vassileva, S. (2003) · AIDS Education and Prevention · doi:10.1521/aeap.15.4.205.23832 · Cited by 105 · see citing works
Self-citationMiller, R. L., Klotz, D., & Eckholdt, H. (1998) · American Journal of Community Psychology · doi:10.1023/a:1021886208524 · Cited by 104 · see citing works
Young, S. D., Holloway, I. W., Jaganath, D., Rice, E. R. W., Westmoreland, D. A., & Coates, T. J. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.301992 · Cited by 104 · see citing works
“Journal American journal of public health, 104(9)”
Patel, V. V., Ginsburg, Z., Golub, S. A., Horvath, K. J., Gutierrez, N. R., Mayer, K. H., Kim, R. S., & Arnsten, J. H. (2018) · JMIR Research Protocols · doi:10.2196/11375 · Cited by 101 · see citing works
“Behavioral interventions using peer leaders have been associated with fostering HIV preventive behaviors [90] and in increased viral suppression in HIV-infected individuals [91].”
Cost-effectiveness of a community-level HIV risk reduction intervention.
Pinkerton, S. D., Holtgräve, D. R., DiFranceisco, W. J., Stevenson, L., & Kelly, J. A. (1998) · American Journal of Public Health · doi:10.2105/ajph.88.8.1239 · Cited by 101 · see citing works
Self-citationTrafimow, D. (2000) · Psychology and Health · doi:10.1080/08870440008402000 · Cited by 96 · see citing works
“These findings are buttressed by research on interventions, indicating that manipulations of attitudes and/or subjective norms affect actual condom use (Kelly et al., 1991; 1992; Middlestadt et al., 1995).”
BackgroundCompulsive Sexual Behavior and Risk for Unsafe Sex Among Internet Using Men Who Have Sex with Men
Men’s INTernet Sex (MINTS-II) Team, Coleman, E., Horvath, K. J., Miner, M., Ross, M. W., Oakes, M., & Rosser, B. R. S. (2010) · Archives of Sexual Behavior · doi:10.1007/s10508-009-9507-5 · Cited by 95 · see citing works
“…and skills (Choi et al., 1996; Dilley et al., 2002; The Explore Study Team, 2004; Wolitski, Gomez, & Parsons, 2005); and two are community level interventions designed to influence community norms regarding the acceptability of safer sex (Kegeles, Hays, & Coates, 1996; Kelly et al., 1991).”
Background(2001) · PsycEXTRA Dataset · doi:10.1037/e548162006-001 · Cited by 96 · see citing works
Effects of Internet Popular Opinion Leaders (iPOL) Among Internet-Using Men Who Have Sex With Men
Ko, N., Hsieh, C.-H., Wang, M.-C., Lee, C., Chen, C.-L., Chung, A., & Hsu, S. T. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2264 · Cited by 91 · see citing works
“However, there was no difference in the number of male online anal sex partners, the number of male partners with UAI, and condom use during anal sex with male sex partners between MSMs visiting the intervention website and those from comparison website.”
ResultInfluentialPeer Educators and Close Friends as Predictors of Male College Students' Willingness to Prevent Rape
Stein, J. L. (2007) · Journal of college student development · doi:10.1353/csd.2007.0008 · Cited by 92 · see citing works
- Authors
- Kelly, J. A., St Lawrence, J. S., Diaz, Y. E., Stevenson, L. Y., Hauth, A. C., Brasfield, T. L., Kalichman, S. C., Smith, J. E., & Andrew, M. E.
- Affiliations
- University of Mississippi Medical Center (US)
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 1991-02
- Volume
- 81
- Issue
- 2
- Pages
- 168-171
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC1404968
- OpenAlex
- W2012749243
- Cited by
- 736
- References
- 10
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 14 · 2023: 7 · 2022: 22 · 2021: 17 · 2020: 17 · 2019: 19 · 2018: 26 · 2017: 25 · 2016: 17 · 2015: 30 · 2014: 31 · 2013: 28 · 2012: 29
- FWCI
- 19.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh042908-11)
- National Institute of Mental Health (R01 MH 42908)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
- Keywords
- HIV risk behavior, peer leaders, opinion leaders, gay men, unprotected anal intercourse, condom use, sexual partners, peer norms, community-based intervention, HIV prevention, gay clubs
- MeSH terms
- Community Participation, Health Education, Homosexuality, Humans, Male, Risk Factors, Sexual Behavior, HIV Infections
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