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Aids and Behavior: An Integrated Approach
successful intervention, therefore, might not result in the elimination of a risk behavior. Instead, a successful intervention is one that advances an individual or group from one stage to another. Two stage models of change have been adapted for use with HIV risk behavior: the AIDS Risk Reduction Model and the Stages of Change Model.
The AIDS Risk Reduction Model (ARRM) (Catania, Kegeles, and Coates, 1990) incorporates elements of the health belief and social cognitive learning models to describe the process through which individuals change their behavior. A goal of this model is to understand why people fail to progress over the change process. ARRM highlights three stages in the change process: Stage One is labeling highrisk behavior as problematic, which incorporates the notion of susceptibility from the health belief models. This involves knowing which sexual activities are associated with HIV transmission, believing that one is personally susceptible to contracting HIV, and believing that having AIDS is undesirable. Stage Two is making a commitment to changing highrisk behaviors, which includes weighing costs and benefits, and evaluating response efficacy, incorporating the efficacy concept from social cognitive learning theory. Stage Three is seeking and enacting solutions, that is, taking steps to actually perform the new behavior and then performing it. This enactment is influenced by social norms and problem-solving options, and it may include seeking help.
The Stages of Change Model (Prochaska, in press; Prochaska and DiClemente, 1983; Prochaska, DiClemente, and Norcross, 1992), formally called the Transtheoretical Model, was developed in the context of psychotherapy and has only recently been applied to HIV risk behavior. The Centers for Disease Control and Prevention, for example, is using the model in its AIDS Community Demonstration Projects, which target hard-to-reach groups at risk for HIV infection (O'Reilly and Higgins, 1991). This model posits four stages of change: Precontemplation, in which the individual does not intend to change behavior within the next six months; Contemplation, in which the individual intends to change behavior within the next six months; Preparation, in which the individual is seriously planning behavior change within the next 30 days, has made some attempt to modify behavior, but has not yet met a specific criterion (such as always using condoms); and Action, in which the individual has modified a behavior and met a specific criterion for less than six months. Maintenance is used to describe the period in which the individual continues the behavior change beyond six months. Movement through these stages