What happened in the SUMIT trial? Mediation and behavior change.
OBJECTIVE
We wished to identify which potential mediators of the Seropositive Urban Men's Intervention Trial (SUMIT) intervention were in fact changed by the intervention, and further to identify which among these factors distinguished men who decreased their risk behavior relative to those who increased it, irrespective of the intervention arm.


METHODS
We examined social cognitive theory and other psychosocial variables that the intervention was designed to affect (potential mediators) in both sets of analyses. These were assessed at baseline, 3-month follow-up, and 6-month follow-up. We tested which potential mediators were changed by the intervention relative to the comparison arm, and which of these factors distinguished men discontinuing risk behavior [unprotected insertive anal intercourse (UIAI) or UIAI with HIV-negative or status-unknown partners] compared with those initiating it.


RESULTS
Factors changed by the intervention included partner serostatus assumption making, hedonistic condom outcome expectancies, anxiety and depression. Factors associated with behavioral risk reduction included personal responsibility to protect others from infection and self-evaluative outcome expectancies regarding transmission risk behavior. These constructs are similar and involve the engagement of moral processes and altruism in sexual behavior with others.


CONCLUSIONS
The present results suggest that, although we designed the intervention to enhance personal responsibility to protect others from HIV, we were not successful in this goal. However, changes in this factor did prove to be an important correlate of behavior change. Possible ways to design and deliver more successful interventions are discussed.
O'Leary
Ann
A
Divisions of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA. aoleary@cdc.gov
Hoff
Colleen C
CC
Purcell
David W
DW
Gómez
Cynthia A
CA
Parsons
Jeffrey T
JT
Hardnett
Felicia
F
Lyles
Cynthia M
CM
D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D001727:Bisexuality / Q000523:psychology*; D003192:Compulsive Behavior; D017280:Condoms / Q000706:statistics & numerical data; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006679:HIV Seropositivity / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D017060:Patient Satisfaction; D010379:Peer Group; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020377:Self Efficacy; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000150:complications; D016896:Treatment Outcome; D047568:Unsafe Sex