This application is in response to the Program Announcement BRIEF INTERVENTIONS TO PREVENT THE SPREAD OF AIDS (PA 95-070) and requests 3 years of support to test brief HIV risk reduction counseling intervention models for men and women at risk for HIV and other sexually transmitted infections. Based on Fisher and Fisher's (1992) Information-Motivation-Behavioral Skills model (IMB), we will systematically manipulate two independent intervention components (motivational enhancement and risk reduction skills building) within the context of a single 60-minute face to face counseling session delivered to sexually transmitted disease (STD) clinic clients. We will recruit 400 women and 400 men from a city STD clinic who meet high-risk behavior criteria. Participants will be randomly assigned to 1 of 4 brief HIV risk reduction counseling experimental conditions: (a) a single 60-minute counseling session that delivers information about HIV sexual transmission risks, motivational enhancement counseling, and cognitive-behavioral skills for HIV risk reduction; or (b) a single 60-minute counseling session that delivers HIV risk reduction information and motivational enhancement without any cognitive-behavioral skills building components; or (c) a single 60-minute counseling session delivering risk reduction information and risk reduction skills building without motivational enhancement components; or (d) a single 60-minute counseling session delivering only HIV risk reduction information without motivational enhancement and without skills building components. Using the proposed 2 (motivational enhancement / no motivational enhancement) X 2 (behavioral skills building / no behavioral skills building) X 2 gender (male/female) complete factorial design we will assess the effects of brief counseling on incident sexually transmitted diseases, sexual risk behaviors, and condom use over 1-, 3-, 6-, and 12-month follow-up periods. We hypothesize that motivational and behavioral skills components will reduce risk, but a significant interaction will show the complete IMB intervention model is most effective in reducing STD and risk behavior outcomes. In addition we will use mediation and cost-effectiveness analyses to further examine the change mechanisms and the utility of the brief interventions tested in the proposed research. Results of the proposed study will guide the allocation of HIV prevention resources in establishing brief and effective HIV risk reduction counseling services for populations vulnerable to HIV infection.
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