While gay men have made significant changes in behavior to reduce risk for HIV infection, there is growing evidence that long-term consistent maintenance of change is difficult for many persons. Because of high HIV prevalence in this population, even infrequent lapses to high-risk behavior confer great risk for contracting or transmitting HIV infection. While relapse has been well-studied in other health behavior areas, there has been very little systematic attention to interventions intended to promote long-term HIV risk behavior change maintenance. In a formative research phase, the proposed study will use focus groups and individual elicitation interviews to identify critical situational, interpersonal, and intrapersonal factors associated with unsuccessful handling of risk behavior lapse urges as well as coping strategies used by homosexually- active men who have been able to successfully resist lapse temptations. The primary study phase will then test the relative impact of four interventions on long-term behavior change maintenance among 600 homosexually-active, continued-risk African-American and white men. Two of the intervention conditions involve 6-hour single group sessions that each include cognitive, attitudinal, and risk-reduction skills training; one of these time-matched interventions will also include specific, intensive training in relapse prevention. The other two conditions will follow the 6-hour core intervention with three group followup sessions and ongoing telephone contacts for 12 months; one of these extended-contact time- matched interventions will also include relapse prevention-training and have followup contacts focused on change maintenance issues while the other will not. This randomized intervention trial will follow participants for 33 months postintervention and utilize multivariate analyses to examine differential intervention impact on indices of risk knowledge, cognitive problem-solving and assertiveness skills relevant to risk reduction implementation, self-reported and self-monitored risk behavior, behavioral and attitudinal intentions, and STD incidence. It is hypothesized that the intervention conditions with specific relapse prevention components will produce, relative to the time-matched conditions without these elements, greater long-term maintenance of risk reduction behavior change. The design will also allow us to explore format, content, delivery, and duration of intervention needed to best promote long-term consistent change; these yet-unstudied issues are of practical importance to public health efforts to curb HIV. The overall intent of this research is to employ and test models for HIV risk reduction which are conceptually based on findings concerning relapse prevention in other health behavior areas and to identify promising intervention strategies for better preparing individuals for the long-term, consistent and perhaps lifelong behavior changes required for the continuing threat of HIV. In addition to HIV prevention, this study is expected to identify better approaches for the prevention of other STD's.
