Research has show that continued high-risk sexual practices among people with HIV infection are related to psychological distress, maladaptive coping, difficulty disclosing HIV serostatus to sex partners, and problems coping with high-risk situations. Although HIV risk reduction interventions based on theories of behavior change have been successfully applied to populations vulnerable to becoming HIV infected, there have been no published studies reporting outcomes from theory- based sexual behavior change interventions for HIV seropositive men. This application requests support to develop and test the effects of an HIV risk reduction intervention designed for HIV seropositive men who continue to practice unsafe sex. The proposed research will begin with a 6-month period of formative study to interview 50 HIV seropositive men and women concerning factors that facilitate and interfere with maintenance of safer sex practices. We will also pilot test our assessment instruments and procedures during this period. Beginning in the second half of the first year of study, we will initiate recruitment of 300 HIV seropositive men who will be randomized to one of two experimental conditions: 91) a 12 session with 3 booster sessions experimental HIV risk reduction intervention based on social cognitive theory of coping and behavior change. The intervention will include five major components; coping skills training, social support network development, communication and self-disclosure skills enhancement, sexual risk reduction skills enhancement, and relapse prevention; or (2) 12 sessions with 3 reunion sessions contact matched control condition which will be structured as a closed support group. The study will specifically test the effectiveness of an intensive, theory-based HIV coping and risk reduction intervention for men who already know they are HIV infected. An emphasis will also be placed on communication and self-disclosure skills enhancement, and relapse prevention. Assessments collected at baseline, immediately following the intervention, and again at 3-months, 6-months, 9-months, and 12-months following the intervention will be used to determine relative intervention effects on mental health, social support, sexual communication and sexual behavior change outcomes. It is hypothesized that the cognitive behavioral skills intervention will result in increased coping and social support compared to the social support group condition, and that the cognitive behavioral intervention will demonstrate increased self-efficacy, intentions, and acts of disclosing HIV serostatus to sex partners, as well as reduction in high-risk sexual practices and increased condom use, over a longer period of time than the support groups. This research will therefore test the effects of a cognitive behavioral coping and risk reduction skills intervention that, if effective, could be readily implemented by health care clinics and AIDS service organizations providing services to HIV seropositive men.
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