Primary Prevention 227by including a health-promotion control group, and partially
replicated the results. Taken together, “ndings from these
studies demonstrate the effectiveness of an intervention that
targets HIV-related motivationas well as behavioral skills.
Subsequently, Belcher et al. (1998) have demonstrated the ef-
fectiveness of a single-session, motivational and skills-based
intervention for 68 women in a community setting.
Jemmott and colleagues (Jemmott, Jemmott, & Fong,
1992, 1998) have developed risk reduction programs speci“-
cally for inner-city minority youth. In an important early study,
Jemmott et al. (1992) assigned 157 African American male
adolescents to receive an intervention, based on the theory of
reasoned action, and aimed at increasing AIDS-related knowl-
edge and weakening problematic attitudes toward risky sexual
behavior, or to receive a control intervention on career oppor-
tunities. They found that the adolescents who received the
AIDS intervention increased their knowledge, reported less
favorable attitudes toward risky sexual behavior and lower in-
tentions to engage in risky behavior, compared to control
participants. Follow-up data collected three months later re-
vealed that the adolescents who had received the AIDS inter-
vention reported fewer occasions of vaginal intercourse, fewer
partners, greater use of condoms, and a lower incidence of het-
erosexual anal intercourse than did the other adolescents.
In a second study, Jemmott et al. (1998) evaluated the ef-
fects of two community-based HIV prevention programs. One
program was abstinence-oriented whereas the second was a
safer-sex program; both were compared to a health promotion
control group using a RCT with 3-, 6-, and 12-month follow-
ups. The interventions took place during eight, one-hour
meetings that were facilitated by adults or peer cofacilitators.
The abstinence intervention stressed delaying intercourse
whereas the safer-sex intervention stressed condom use. The
sample, 659 inner-city African American adolescents, was re-
cruited from three middle schools serving low-income com-
munities in Philadelphia. The results were quite interesting. At
the 3-month follow-up, abstinence intervention participants
were less likely to report having sexual intercourse than were
control group participants, but this effect weakened at the
follow-ups. Participants in the safer-sex intervention reported
more consistent condom use than did control group partici-
pants at 3 months and higher frequency of condom use at all
follow-ups. Among adolescents who reported sexual experi-
ence at baseline, the safer-sex intervention group reported less
sexual intercourse at 6- and 12-month follow-ups than did the
control and abstinence intervention and less unprotected
intercourse at all follow-ups than did control group. The re-
sults indicate that both abstinence and safer-sex interventions
reduced HIV sexual risk behaviors, but that safer-sex inter-
ventions may be more effective with sexually experienced
adolescents, and that they may have longer-lasting effects.
Stanton et al. (1996) focused their efforts onnaturally
formed peer groups.In a RCT, they studied 76 groups con-
sisting of 383 (206 intervention and 177 control) African
American youths aged 9 to 15. The intervention was based on
protection motivation theory (R. W. Rogers, 1983). The
assessment focused on perceptions, intentions, and sexual be-
havior; it was administered to all adolescents at preinterven-
tion, and at 6- and 12-month follow-ups. The results indicated
that condom use was higher among intervention than control
youths (85% vs. 61%) at the 6-month follow-up. The inter-
vention impact at 6 months was strongest among boys
and early teens. However, by 12 months, condom use was
no longer higher among intervention youths. Intentions to
use condoms also increased among intervention youths at
6 months but not at 12 months. Some perceptions were posi-
tively affected at 6 months, but the change did not persist at
12 months. The attenuated effects seen at the follow-up are
consistent with results from other studies.Community-Wide Approaches. Kelly is also responsi-
ble for a second in”uential approach to HIV risk reduction,
namely the popular opinion leader (POL) or social diffusion
model. This approach draws on the diffusion of innovation/
social in”uence principles (E. M. Rogers, 1983), and posits
that innovations often result from the efforts of a relatively
small segment of •opinion leadersŽwho initially adopt a new
practice and subsequently encourage its adoption by others.
Gradually, the initial adoption, modeling, and encouragement
by POLs results in the diffusion of innovations throughout a
population.
Kelly et al.•s initial study (1991) took place in three small
cities in the southern United States. Two cities served as con-
trols and one city served as the intervention city. Across the
three cities, a total of 659 gay men completed surveys at two
baseline periods. The intervention involved identifying 43
popular opinion leaders in gay bars, training these men in
HIV risk education and skills training, and contracting with
them to endorse behavior change to their peers while in the
bar settings. At the postintervention assessment, 608 men
completed surveys. In the intervention city, the proportion
of men who engaged in unprotected anal intercourse over a
2-month period decreased from 37% to 27%. Relative to
baseline levels, there was a 16% increase in condom use dur-
ing anal intercourse and an 18% decrease in the proportion of
men with more than one sexual partner. In contrast, there was
little change in risk behavior among men in the comparison
cities. A second study replicated the effectiveness of the POL
model in three cities (Kelly et al., 1992), and a third project
has extended the initial “ndings to four more cities (Kelly,
Murphy, Sikkema, et al., 1997). Subsequent extensions of the
POL model to younger gay men (Kegeles, Hays, & Coates,