Kelly J A, St Lawrence J S, Diaz Y E, Stevenson L Y, Hauth A C, Brasfield T L, Kalichman S C, Smith J E, Andrew M E
University of Mississippi Medical Center, Jackson.
Am J Public Health. 1991 Feb;81(2):168-71. doi: 10.2105/ajph.81.2.168.
Peer norms influence the adoption of behavior changes to reduce risk for HIV (human immunodeficiency virus) infection. By experimentally intervening at a community level to modify risk behavior norms, it may be possible to promote generalized reductions in HIV risk practices within a population.
We trained persons reliably identified as popular opinion leaders among gay men in a small city to serve as behavior change endorsers to their peers. The opinion leaders acquired social skills for making these endorsements and complied in talking frequently with friends and acquaintances. Before and after intervention, we conducted surveys of men patronizing gay clubs in the intervention city and in two matched comparison cities.
In the intervention city, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent to 27.5 percent (-25 percent from baseline), with a reduction from 27.1 percent to 19.0 percent (-30 percent from baseline) for unprotected receptive anal intercourse. Relative to baseline levels, there was a 16 percent increase in condom use during anal intercourse and an 18 percent decrease in the proportion of men with more than one sexual partner. Little or no change was observed among men in the comparison cities over the same period of time.
Interventions that employ peer leaders to endorse change may produce or accelerate population behavior changes to lessen risk for HIV infection.
同伴规范会影响为降低感染人类免疫缺陷病毒（HIV）风险而做出行为改变的情况。通过在社区层面进行实验性干预以改变风险行为规范，有可能促使人群中HIV风险行为普遍减少。
我们对一个小城市中可靠地被认定为男同性恋群体中舆论领袖的人进行培训，使其成为同伴行为改变的支持者。这些舆论领袖掌握了进行此类支持的社交技能，并坚持经常与朋友和熟人交流。在干预前后，我们对干预城市以及两个匹配的对照城市中光顾同性恋俱乐部的男性进行了调查。
在干预城市，在两个月期间有过任何无保护肛交行为的男性比例从36.9%降至27.5%（较基线水平下降25%），无保护被动肛交行为的比例从27.1%降至19.0%（较基线水平下降30%）。与基线水平相比，肛交时使用避孕套的比例增加了16%，有多个性伴侣的男性比例下降了18%。在同一时期，对照城市的男性中几乎没有观察到变化。
采用同伴领袖来支持行为改变的干预措施可能会促使或加速人群行为改变，以降低HIV感染风险。
