title: Changing sexual behavior among gay male repeat testers for HIV: a randomized, controlled trial of a single-session intervention.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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 cognitive-behavioral intervention, and two control groups received only standard HIV test counseling. Follow-up evaluation was at 6 and 12 months.
  
  
  METHODS
  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.
authors.affiliation: AIDS Health Project (UCSF-AHP), San Francisco, CA 94143-0884, USA. jdilley@itsa.ucsf.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Dilley
authors.forename: William J
authors.initials: WJ
authors.lastname: Woods
authors.forename: James
authors.initials: J
authors.lastname: Sabatino
authors.forename: Tania
authors.initials: T
authors.lastname: Lihatsh
authors.forename: Barbara
authors.initials: B
authors.lastname: Adler
authors.forename: Shannon
authors.initials: S
authors.lastname: Casey
authors.forename: Joanna
authors.initials: J
authors.lastname: Rinaldi
authors.forename: Richard
authors.initials: R
authors.lastname: Brand
authors.forename: Willi
authors.initials: W
authors.lastname: McFarland
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D003376:Counseling; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control* / Q000523:psychology; D006679:HIV Seropositivity / Q000175:diagnosis; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012725:Sexual Behavior