A meta-analysis (k of conditions = 128; N = 4,598) examined the influence of factors present at the time an attitude is formed on the degree to which this attitude guides future behavior. The findings indicated that attitudes correlated with a future behavior more strongly when they were easy to recall (accessible) and stable over time. Because of increased accessibility, attitudes more strongly predicted future behavior when participants had direct experience with the attitude object and reported their attitudes frequently. Because of the resulting attitude stability, the attitude-behavior association was strongest when attitudes were confident, when participants formed their attitude on the basis of behavior-relevant information, and when they received or were induced to think about one- rather than two-sided information about the attitude object.

This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIVprevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts. Keywords behavior change; active intervention; HIV; health; communicationThe development of effective health behavior interventions and adequate understanding of the processes that underlie change to risky behavior continues to top the agenda for reducing disease and death among at-risk populations. For example, infection with HIV has been diagnosed in almost 1 million people in the United States (Centers for Disease Control [CDC], 2003) as well as an estimated 40 million worldwide (UNAIDS/ WHO Working Group, 2002). In some countries, the epidemic continues to escalate, and even in nations that have successfully Copyright 2005 by the American Psychological AssociationCorrespondence concerning this article should be addressed to Dolores Albarracín, Department of Psychology, University of Florida, Gainesville, FL 32611. E-mail: E-mail: dalbarra@ufl.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript curbed the spread of the disease, certain groups still show increases in infection rates (see, e.g., CDC, 2003). Given these distressing figures, it is no surprise that research on HIV prevention has become increasingly important and progressively more sophisticated. Indeed, HIV prevention presently constitutes one of the most significant paradigms for the discovery of health behavior change techniques and for the understanding of the theoretical processes that underlie such change.In fact, the HIV epidemic of the 1980s stimulated the uniting of funds and expertise from various disciplines in the development of a shared behavior-change paradigm. As a key example, in 1992, a group of behavioral researchers joined forces-upon request from the National Institutes of Health-to develop a paradigm for behavior change that would guide research and practice in the prevention of HIV (see Fishbein et al., 1992). Various models were examined, and the key assumptions were condensed into a limited number of premises that illuminated preventive efforts.Although the various models had independently received broad support, this support was derived almost entirely from behavior prediction studies. However, the formulation of these general assumptions contributed to...

We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection. KeywordsHIV; AIDS; structural factors; diagnosis; prevention Structural interventions have had a profound impact on public health. Even a casual observer of history can see the connection between structural changes such as water purification or highway safety and reductions in morbidity and mortality. Structural interventions can have a tremendous effect on individual-level health behaviors as well. Legislative changes such as regulating tobacco sales and usage have led individuals to modify their health behaviors and dramatically reduced smoking rates. 1Although structural approaches to health promotion are clearly effective, they are often viewed as outside the purview of behavioral interventionists. Prevailing conceptions of "cause" as immediate and necessary antecedents of health outcomes consider factors that affect outcomes in more indirect and indefinite ways as less important or less relevant. 2,3 Structural factors have also been neglected because researchers in the field of HIV prevention are often unprepared to develop and evaluate strategies to change laws, social organizations, or physical structures. Moreover, because of the scope and focus of structural interventions, randomized controlled trials, the gold standard to evaluate interventions'

This meta-analysis examines whether exposure to HIV-prevention interventions follows selfvalidation or risk-reduction motives. The dependent measures used in the study were enrolling in an HIV-prevention program and completing the program. Results indicated that first samples with low prior condom use were less likely to enroll than samples with high prior condom use. Second, samples with high knowledge were less likely to stay in an intervention than were those with low knowledge. Third, samples with medium levels of motivation to use condoms and condom use were more likely to complete an intervention than were those with low or high levels. Importantly, those patterns were sensitive to the interventions' inclusions of information-, motivation-, and behavioral-skills strategies. The influence of characteristics of participants, the intervention, and the recruit procedure are reported. KeywordsHIV prevention; behavioral interventions; retention; recruitment; attitudes The need to develop behavioral interventions to reduce infection with HIV and other sexually transmitted infections (Centers for Disease Control [CDC], 2005) has resulted in many evidence-based interventions that attempt to increase HIV-relevant knowledge, motivation, and behavioral skills (J. D. Fisher & Fisher, 1992). Although these programs have been shown to be efficacious in meta-analytic syntheses and multisite trials (e.g., Albarracín et al., 2005;Albarracín et al., 2003; B. T. Johnson, Carey, Marsh, Levin, & Scott-Sheldon, 2003; Kim, Stanton, Li, Dickersin, & Galbraith, 1997;Mize, Robinson, Bockting, & Scheltema, 2002;Prendergast, Urada, & Podus, 2001), there is a surprising lack of understanding of the programs' outreach. However, it is important to determine if the programs reach and retain audiences that lack appropriate knowledge, motivation, and behavioral practice, and if specific aspects of these programs increase outreach and retention.Correspondence concerning this article should be addressed to Kenji Noguchi or Dolores Albarracín, Department of Psychology, University of Florida, Gainesville, FL 32611. knoguchi@ufl.edu or dalbarra@ufl.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptThe limitations in our knowledge about outreach may be due in part to the researchers' needs to test programs under conditions that increase participation and reduce attrition. In doing so, researchers provide strong incentives for participation and perceive low retention as a serious threat to be minimized. Despite the value of these practices to assess intervention efficacy, an informed take on outreach requires understanding natural variability in intervention acceptance and retention rather than conceptualizing attrition as a rate that must be constant and low. For this reason, we meta-analyzed the HIV-prevention intervention literature with a focus on variations in the sample sizes within included studies. From sample sizes at different study points, acceptance and retention rates were calculate...

Criminializing nondisclosure of HIV serostatus does not reduce sexual risk behavior. Although the laws do not appear to increase stigma, they are also not likely to reduce HIV transmission.