Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information

Intervention Description

Target Population
Men who frequent gay bars

Goals of Intervention

• Eliminate or reduce sex risk behaviors

Theoretic Basis

• Diffusion of Innovations

Intervention Duration
Ongoing

Intervention Settings
Gay bars

Deliverer
Popular opinion leaders who are trusted, well-liked men frequenting gay bars, and trained to endorse safer sex behaviors

Delivery Methods

• POL training
• Goal setting
• Group discussion
• Modeling
• Role play
• Skill building
• Casual, one-on-one conversations
• Printed materials (logos, symbols, other devices)

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Intervention Package Information

An intervention package was developed with funding from CDC’s Replicating Effective Programs (REP) Project. The intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.

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Evaluation Study and Results

The original evaluation was conducted in Biloxi, MS; Hattiesburg, MS; and Monroe, LA between 1989 and 1991.

Key Intervention Effects

• Reduced unprotected anal intercourse
• Increased condom use
• Reduced number of sex partners

Study Sample
The baseline study sample of 659 men in 3 communities is characterized by the following:

• 86% White; 14% African American or Hispanic
• 100% Male
• 100% MSM
• Mean age of 29 years
• Mean education level:15 years

Recruitment Settings
Gay bars

Eligibility Criteria

• The eligible communities were small cities (50,000 to 75,000 residents) that were separated by at least 60 miles from another city included in study or any other larger city (> 75,000 residents) and had one or two large gay bars.
• Men were eligible for assessment if they frequented gay bars in the eligible communities.

Assignment Method
One city (Biloxi, Mississippi) was randomly selected to receive the intervention and the remaining two cities (Hattiesburg and Monroe, Mississippi) served as comparison cities.

Comparison Group
The comparison cities received no specific intervention, but AIDS prevention brochures and posters were generally available in gay bars.

Relevant Outcomes Measured and Follow-up Time

• Sex behaviors during past 2 months (including any unprotected anal intercourse, unprotected receptive anal intercourse, or unprotected insertive anal intercourse; condom use during any anal intercourse, receptive anal intercourse, or insertive anal intercourse; and number of sex partners) were measured at baseline and 3 to 6 months post intervention

Participant Retention
Not applicable due to cross-sectional samples¹

Significant Findings

• Participants in the intervention city reported significantly greater reductions in any unprotected anal intercourse (including any, receptive or insertive) than participants in the two comparison cities (all p’s < .05).
• Participants in the intervention city reported significantly greater increases in condom use during anal intercourse (including any, receptive or insertive) than participants in the comparison cities (all p’s < .05).
• Participants in the intervention city reported significantly greater reductions in having multiple sex partners than participants in control communities (p < .05).

Considerations

• This intervention fails to meet the best-evidence criteria due to insufficient number of communities (1 city received the intervention; 2 cities served as comparison cities).
• Intervention efficacy was evaluated by comparing the first city to receive the intervention (Biloxi) to two comparison cities (Hattiesburg and Monroe). The intervention was evaluated in all three cities using a sequential stepwise lagged design. The intervention produced reductions in high-risk behaviors (e.g., unprotected anal intercourse) with the same pattern of effects replicated in all three cities (Kelly et al., 1992).
• Additional evidence is found in a replication study conducted by Kelly et al., 1997. However, this replication intervention fails to meet the promising-evidence criteria due to excluding 8 (4 intervention and 4 comparison) of 16 intended communities and dropping participants who were transient or exclusively partnered (32% of baseline assessment and 39% of follow-up assessment) from the analysis.
• Additional evidence is found in an adaptation study conducted by Jones et al., 2008 for African American MSM. This adaptation study also fails to meet the promising-evidence criteria due to lack of a comparison arm.

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References and Contact Information

• Kelly, J. A. et al. (1991). HIV risk behavior reduction following intervention with key opinion leaders of population: An experimental analysis. American Journal of Public Health, 81, 168-171.
• Kelly, J. A. et al. (1992). Community AIDS/HIV risk reduction: The effects of endorsements by popular people in three cities. American Journal of Public Health, 82, 1483-1489.
• Kelly, J. et al. (1997).  Randomised, controlled, community-level intervention, HIV-prevention intervention for sexual risk behaviour among homosexual men in US cities. The Lancet, 350, 1500-5.
• Jones, K. et al. (2008). Evaluation of an HIV prevention intervention adapted for Black men who have sex with men. American Journal of Public Health, 98, 1043-1050.
  
  Researcher:
  Jeffrey A. Kelly, PhD
  Department of Psychiatry and Mental Health Sciences
  Medical College of Wisconsin
  701 Watertown Plank Road
  Milwaukee, WI 53226
  email: kdemming@mcw.edu

¹The evaluation did not follow a cohort of participants across time, but selected a different representative sample of community members at each assessment.

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