OBJECTIVE: High-risk sexual behavior remains common among gay men who live in many small cities. This research experimentally examined if population-wide risk reduction could be produced by engaging popular social opinion leaders to serve as behavior change endorsers to their peers. METHODS: Baseline risk behavior levels were obtained by surveying all men entering all gay clubs in 3 small, isolated cities (N=430). In one city (experimental), ratings were used to identify a subset of persons most popular among gay men in their social networks. These opinion leaders attended group sessions which taught steps for implementing risk reduction, trained social skills for endorsing these steps, and contracted with participants to serve as change endorsers to friends. In control cities, standard AIDS educational materials were present in clubs. After intervention, surveys were repeated in all cities (N=448 men) to ascertain shifts in population risk characteristics. RESULTS: At baseline, 40% of men in each city reported unprotected anal intercourse in the preceding two months. At the postintervention point, no significant change was found in the control cities. However, significant population-wide reductions (-36% from baseline) in unprotected anal intercourse and significant increases in safer sex practices were found in the experimental city. Increased rates of condom-taking in gay clubs corroborated these changes. CONCLUSIONS: Interventions which engage key opinion leaders can produce population-wide shifts in risk behavior and norms. In addition to gay men, this model appears very promising for other peer-sensitive populations such as adolescents and IVDUs.

Acquired Immunodeficiency Syndrome/*PREVENTION & CONTROL Contraceptive Devices, Male *Health Education *Health Plan Implementation Homosexuality Human Male Peer Group *Public Opinion Risk Factors *Sex Behavior United States *Urban Population ABSTRACT

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