This 4-year project, in response to PA 94-054, will test the efficacy of a theoretically informed intervention to reduce the risks of HIV infection among men who solicit money for sex. The study has two related purposes. First, the study will identify the cognitive, behavioral, and social precursors of sexual risk behaviors and apply this information to the development of a sexual risk reduction intervention. Second, the study will empirically test the efficacy of the developed intervention to reduce sexual risk. The study will be conducted in two phases reflecting the dual purposes of the study. Both phases of the study will be informed by the Information-Motivation-Behavioral skill (IMB) model of AIDS risk reduction developed by Fisher and Fisher. Phase 1 of the study is exploratory. Phase 1 will elicit the range of cognitive, social, and contextual factors that influence sexual risk behavior among male prostitutes.
The specific aims of Phase 1 are: 1) to identify the information, motivation, and behavior factors that influence adoption of sexual risk reduction behaviors; 2) to identify demographic, drug use, and other personal history factors that may facilitate or hinder the adoption of specific sexual risk-reducing behaviors; and 3) to assess the interrelationships among factors potentially influencing sexual risk of HIV infection and assess the likely impact of these multiple factors on the development of appropriate and realistic intervention strategies to reduce the risk of HIV infection among male prostitutes. Phase 1 will be conducted using data from 46 semi-structured interviews and 2 focus groups. Interviews and focus groups will likely be multiple sessions. Data generated from the guided interviews and focus groups will be used to provide a thick description of the structures of HIV information, motivation, and behavioral skills within a context of male prostitution. This information will be the basis for developing the sexual risk reduction intervention to be tested in Phase 2. Phase 2 of the study will implement and evaluate the efficacy of a sexual risk reduction intervention. The exact design of the intervention will not be known until after completion of Phase 1 studies. However, pilot studies conducted by the coinvestigators suggest that an intervention targeting the behavioral skills domain of the IMB model will likely prove successful. The test of the intervention will be conducted using a field experimental design. During phase 2, 242 male prostitutes matching study criteria will be recruited. Participants will be assigned to either the sexual risk reduction intervention or a quasiexperimental control group. The control group will receive a general health enhancement intervention. Examination of study outcomes will focus on change in stage of change and overt risk behaviors. Outcome analysis will include a longitudinal assessment of change. The explanatory power of the IMB model will also be examined.
| Williams, Mark L; Atkinson, John; Klovdahl, Alden et al. (2005) Spatial bridging in a network of drug-using male sex workers. J Urban Health 82:i35-42 |
