title: HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: University of Mississippi Medical Center, Jackson.
authors.forename: J A
authors.initials: JA
authors.lastname: Kelly
authors.forename: J S
authors.initials: JS
authors.lastname: St Lawrence
authors.forename: Y E
authors.initials: YE
authors.lastname: Diaz
authors.forename: L Y
authors.initials: LY
authors.lastname: Stevenson
authors.forename: A C
authors.initials: AC
authors.lastname: Hauth
authors.forename: T L
authors.initials: TL
authors.lastname: Brasfield
authors.forename: S C
authors.initials: SC
authors.lastname: Kalichman
authors.forename: J E
authors.initials: JE
authors.lastname: Smith
authors.forename: M E
authors.initials: ME
authors.lastname: Andrew
mesh_terms: D003256:Community Participation; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education; D006716:Homosexuality; D006801:Humans; D008297:Male; D012307:Risk Factors; D012725:Sexual Behavior