The HIV epidemic has had a dramatic impact on the lives of individuals, families, and communities around the world. Originally identified in homosexual men, HIV increasingly affects others, including: (1) those who inject drugs, (2) non-injection drug users who engage in unsafe sex, and (3) non-drug using heterosexuals who engage in high-risk sexual behaviors. The need for effective HIV prevention interventions is critical. All too often interventions have lacked sound theoretical frameworks. However, some attempts have been made to ground HIV risk behavior interventions in behavior theories such as: (1) the health belief model, (2) cognitive social learning theory, (3) the theory of reasoned action, and (4) the transtheoretical model of behavior change (TMBC). This paper describes an HIV prevention intervention that was developed from the TMBC model. The TMBC model hypothesizes stages of change. In this study, injection drug users (IDUs), crack cocaine users (CCUs), and female sexual partners of IDUs and CCUs identified their stage of change and were given an intervention based upon their identified stage. Baseline and post intervention follow-up data were obtained on participants' perceived stage and reported HIV sexual risk behavior. The data indicated that there was little congruence between perceived stage and reported risk. In spite of this incongruence, significant decreases in HIV risk behaviors were evidenced.
Evidence of high-risk sexual behaviors among injection drug users in the Kenya PLACE study