Thisanicle contains a comprchcnsivc. critical rwicw of the acquirc'd immunodcficicncy syndrome (AIDSFrisk-reduction literature on interventions that have targeted risky sexual behavior and intravenous drug use practices. A conceptually based, highly gcncnlizable model for promoting and evaluating AIDS-risk behavior change in any population of intemt is then proposed. The modcl holds that AIDS-risk reduction isa function of people's information about AIDS transmission and prcvcntion, their motivation to rcducc A i h risk. and their behavioral skills for performing the specific acts involved in risk rcduaion. Supportive tats of this model, using structural equation modeling techniques, arc then rcponed for populationsof university studentsand gay malca5nity group members.Acquired immunodeficiency syndrome (AIDS) hasbecorrone of the major public health thrr;ts of the twentieth century. This disease is caused by human immunodeficiency virus (HIV) and is transmitted through sexual contact and blood and body fluid vectors. AIDS has already been diagnosed in over 196,000 Americans (Centers for Disease Control, 199 1 ), and a cumulative 390,000-480.000 AIDS cases are expected in the United States by the end of 1993 (Centers for Disease Contrc!. 1992). An estimated 1.5 million Americansarecurrcntly asymp tomatic carriers of HIV (U.S. Public Health Service. 1988); these people arc both infectious to othcn and likely to develop AIDS themselves. AIDS has already had devastating e K e a in populations of gay men (Centers for Disease Control. 1990). minorities ' (Mays, 1989; Quimby & Fricdman. 1989). parcnteral drug users and thcir partners and children (Dcs Jadaisct al, 1989; McCoy & Khoury, 1990), and hemophiliacs (Stehr-G m n , Holman. Jason, & Evatt, 1988); widence suggests that the general hcterosexually active public is increasingly at riskas well (Burke et al, 1990; Gordin, Gilbert, Hawley, & Willoughby, 1990; T. E. Miller, Booraem, Flowen, & Iverscn, 1990; St. Louis et al, 1990).Because HIV is communicated by specific patterns of risky behavior, it can be prevented by appropriate behavioral change.' For example, when practictd with HIV-infected partwrs, anal intercourx, vaginal intercourse, and the sharing of unclean needles have been identified as behavion that pose This research was Supported by grants from the National Instituteof Mental Health (1 -ROI -MH462240 1 ) and the Social Sciences and Humanitia Research Council of Canada (410-87-19333) Moses. 1990). It is possible for people to avoid these behavion, or to engage in safer variantsof them (eg, to use condoms when engaging in potentially risky sexual acts, to clean needles with bleach before sharing them), and thus to reduce their risk of HIV infection. However, behavior change in the direction of prevention remains inconsistent among gay men (Hays, Kcgcles, & Coats, 1990; Kelly & St. Lawrence, 1990; McCombs & White, 1990, Stall, Coates, & Hoff, 1988. minorities (Mays & Cochran. 1988). hemophiliacs (Centers for Discax Control, 1987; Clcmow et al, 1989)...

HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.

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The MALES study confirms the high prevalence rates of ED and its association with co-morbid medical conditions, such as diabetes and depression, reported in other large-scale, epidemiological studies. Despite the advent of oral phosphodiesterase inhibitors, only 58% of ED sufferers consult a physician about their problem, and only 16% of men with self-reported ED maintain their use of oral therapy.

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