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Past studies have primarily focused on individual-level factors influencing the HIV risk practices of gay or bisexual men. The role of one's social network has been less explored. This study identified 75 indexes in venues frequented by men who have sex with men and then recruited all willing persons named as members of each index's egocentric social network. Two hundred fifty-five unique network members completed assessments of risk-related characteristics and also sociometric measures that were used to identify the influence leader of each network. White and African American networks were composed primarily of men of the same race. Over 70% of men reported recent casual sexual partners. About one fourth of men engaged in unprotected anal intercourse (UAI) with a casual partner or with multiple partners in the past 3 months. The social network to which a man belonged, weaker risk reduction intentions, and greater substance use independently predicted a range of high-risk sexual behaviors. There were modest but significant correlations between the risk-related characteristics of network members and network leaders. Social network-level approaches are feasible for reaching hidden subgroups of MSM at high risk for contracting HIV.

Adults with severe mental illness are at high risk for human immunodeficiency virus (HIV) infection and transmission. Small-group interventions that focus on sexual communication, condom use skills, and motivation to practice safer sex have been shown to be effective at helping mentally ill persons reduce their risk for HIV. However, the cost-effectiveness of these interventions has not been established. We evaluated the cost-effectiveness of a 9-session small-group intervention for women with mental illness recruited from community mental health clinics in Milwaukee, Wisconsin. We used standard techniques of cost-utility analysis to determine the cost per quality-adjusted life year (QALY) saved by the intervention. This analysis indicated that the intervention cost $679 per person, and over $136,000 per QALY saved. When the analysis was restricted to the subset of women who reported having engaged in vaginal or anal intercourse in the 3 months prior to the baseline assessment, the cost per QALY saved dropped to approximately $71,000. These estimates suggest that this intervention is marginally cost-effective in comparison with other health promotion interventions, especially if high-risk, sexual-active women are preferentially recruited.

Small-group HIV prevention interventions that focus on individual behavioural change have been shown to be especially effective in reducing HIV risk among persons with severe mental illness. Because economic resources to fund HIV prevention efforts are limited, health departments, community planning groups and other key decision-makers need reliable information on the cost and cost-effectiveness (not solely on effectiveness) of different HIV prevention interventions. This study used an economic evaluation technique known as cost-utility analysis to assess the cost-effectiveness of three related cognitive-behavioural HIV risk reduction interventions: a single-session, one-on-one intervention; a multi-session small-group intervention; and a multi-session small-group intervention that taught participants to act as safer sex advocates to their peers. For men, all three interventions were cost-effective, but advocacy training was the most cost-effective of the three. For women, only the single-session intervention was cost-effective. The gender differences observed here highlight the importance of focusing on gender issues when delivering HIV prevention interventions to men and women who are severely mentally ill.

Young men who have sex with men (YMSM), and particularly ethnic minority YMSM, experience high incidence HIV infection due to continued patterns of high-risk sexual behaviour. The intent of this research was to systematically solicit input and recommendations from YMSM themselves concerning the kinds of HIV prevention programmes that would best meet their needs and would address risk issues they believed are critical. In-depth qualitative interviews were conducted with a sample of 72 purposively selected YMSM to identify necessary components of HIV prevention targeting YMSM. Respondents noted a need for comprehensive HIV prevention programmes that addressed issues related to dating and intimacy, sexuality and arousal, drugs and alcohol, self-esteem and self-worth, abuse and coercion, and sexual identity. Respondents emphasized the importance of keeping programmes confidential, fun, comfortable, accepting and open to all YMSM regardless of sexual identity. Identified community resource needs included safe havens for youth, more peer educators and older MSM mentors, increased school-based sexuality education, and greater support from the society at large as well as from churches, the gay community and communities of Color. Implications of these findings for HIV prevention are discussed.

Minority women constitute the fastest-growing segment of the American epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The present study examined the psychological and social factors related to HIV risk among 153 African-American inner-city women who completed measures of HIV risk history, sexual and substance use behaviors, perceived risk for HIV infection, self-efficacy to reduce risk (belief that one can effectively perform specific behaviors), and perceived social norms supporting risk reduction. Fifty-five percent of the women (n = 84) reported at least one factor that had placed them at known risk for HIV infection. Results of a stepwise regression analysis showed that HIV risk history was associated with self-perceived risk for HIV infection and self-efficacy to perform risk-reducing actions. Social norms for safer sex did not contribute significantly to the explained variance. Women at risk were more likely to have been forced or coerced into unwanted sex and were less likely to have been familiar with their most recent sex partner. These result suggest that HIV risk-reduction interventions targeting inner-city women should focus on skills training approaches to build self-efficacy and empower women to adopt risk-reducing practices.