Young gay men are becoming infected with HIV at alarming rates, HIV prevention programs tailored specifically to the unique needs and subculture of young gay men are urgently needed. However, very few HIV prevention interventions for gay men have been scientifically evaluated, thus very' little is known about the effectiveness of various prevention approaches, the mechanisms by which they work, and their impact on the target population. In our original grant, we developed, implemented and evaluated an innovative community-level HIV prevention program for young gay men in three small communities (Santa Cruz, Eugene, Santa Barbara). Using a strategy based on diffusion of innovations theory, the intervention used a system of peer outreach and small groups to promote HIV risk reduction among young gay men. Longitudinal survey assessments demonstrated the program significantly reduced the percentages of men engaging in unprotected anal intercourse, and their frequencies of doing so, following intervention. In this proposal, we revise and strengthen the previous intervention design, evaluate the degree to which the enhanced intervention increases the effectiveness of the original model, and examine the mechanisms by which the intervention works. The major change in the proposed intervention from our previous intervention is the incorporation of a formalized community-organizing approach intended to develop the young gay men's sense of community, build social networks among young gay men, and empower young gay men with the skills, motivation and resources to shape their community, in such a way that HIV prevention is embedded into the foundation of their community. The intervention targets psychosocial variables which we have found in previous research to be contributors to HIV risk-taking among young gay men, and includes four central elements: I) the creation of a per-run decision-making body, 2) a system of peer outreach by which young gay men will become involved in communicating the need for safer sex to their peers in formal and informal settings, 3) a series of peer-led small groups for young gay men which provide motivational and skills-training for adopting and promoting safer sex, and 4) an ongoing publicity campaign within the gay community. We will implement the original intervention developed in our previous grant in one medium-sized community (Fresno) and the enhanced intervention in two comparison communities (Albuquerque and Tucson). A non-intervention control community (Austin) is also included. A multiple baseline design using longitudinal survey data will be used to evaluate the interventions immediate and long -term effects and examine the mechanisms b which the interventions work.
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