The development of behavioral interventions to increase """"""""safer"""""""" sex practices of HIV+ individuals has the potential to significantly reduce the number of new infections. The overarching objective of this application is to evaluate the effectiveness of an intervention designed to reduce high risk sexual behaviors of HIV+ individuals. Behavioral change effects will be focused on condom use, negotiation of safer sex practices, and disclosure of HIV+ status to sex partners--three areas identified as problematic for HIV+ individuals who completed the investigators' survey of sexual risk behaviors. In addition, the investigators propose to test the efficacy of a brief targeted intervention which focuses behavioral change efforts on problem areas that are unique to an individual. Because time and effort will be channeled into changing only those behaviors that are identified as problematic for an individual, a brief targeted intervention approach may be useful in clinic settings where diverse groups of HIV+ individuals seek medical care. To facilitate identification of high risk sexual behaviors, the investigators have developed a computerized Sex Risk Appraisal (SRA), which yields a personalized """"""""bar chart"""""""" profile, which will be used by a counselor to identify problem areas to be targeted in a counseling session. The proposed intervention--TRIPLE """"""""S"""""""" (SHARE SAFER SEX)-- will utilize a randomized, pretest, multiple posttest, control group design. The four group design addresses the question of how intensive (time and content) an intervention is necessary to be, to achieve behavioral change. Four hundred sexually active HIV+ men and women will be randomly assigned to one of four conditions: (1) a brief (90 minute) one-session targeted intervention focused on problem areas identified through the SRA; (2) the same one-session targeted intervention, plus two 90-minute booster sessions to reinforce behavior change; (3) a comprehensive (three 90-minute session) intervention that covers all three outcome domains; and (4) an attention-control condition (three 90-minute sessions) which addresses diet and exercise as related to HIV. Participants will be randomly assigned to an intervention condition or the attention control group. Followup assessments will be conducted at 4-, 8-, and 12-months post intervention. The design of the intervention was guided by the principle of social cognitive theory. Skill-building exercises, demonstrations, role playing, rehearsal, and positive reinforcement are the main techniques that will be utilized to enhance knowledge, self-efficacy, and positive outcome expectancies in the process of attaining desired behavioral change. Repeated measures analysis of variance will be used to evaluate the effectiveness of the intervention. Moreover, subgroup differences in the effectiveness of the intervention based on gender, ethnicity, and key psychosocial factors (e.g., alcohol/drug use) will be explored.
