behavior in response to information regarding STDs, including HIV infection, provided through a variety of clinical and other settings. Although the task force determined that the effectiveness of clinician counseling in the primary care setting is unproven, the group recommended that primary care clinicians counsel their adolescent and adult patients regarding measures to prevent STDs, and that such counseling should be tailored to the risk factors, needs, and abilities of each patient (U.S. Preventive Services Task Force, 1996). The CDC and several physician organizations have also recommended that primary care clinicians counsel their adolescent and adult patients regarding measures to prevent STDs (ACOG, 1992; AMA, 1993; CDC, 1993a; AAP, Committee on Adolescence, 1994; AAFP, 1994). Clinician counseling does not work in isolation and is a necessary component of appropriate clinical management of STDs. This is because clinician counseling takes advantage of opportunities to educate patients when they are most receptive to health messages and effectively reinforces messages from other sources (Bigelow et al., 1986).
Couple-based interventions to prevent high-risk sexual behaviors are also promising approaches to prevention. In this approach, both members in a relationship are the focus of an intervention. Perhaps the best evidence to support the effectiveness of such an approach is from HIV counseling studies among discordant couples.1 In one study, after multiple HIV testing and counseling sessions, condom use among discordant couples increased from 4 percent to 57 percent after one year of follow-up (Allen et al., 1992).
Community-based interventions to promote behavior change include interventions that target specific high-risk groups, such as female sex workers and adolescents, as well as interventions that attempt to change community norms, most commonly through mass media messages. A number of intervention trials involving high-risk groups such as gay men (Kelly et al., 1991, 1992), injection drug users and their sex partners, female sex workers, and youth in high-risk situations have been successful in improving knowledge and promoting behavior change (O'Reilly and Higgins, 1991; IOM, 1994). Some interventions have been modeled after the Diffusion of Innovation Theory and have successfully utilized peer opinion leaders and educators to change norms in a community by endorsing condoms and educating regarding their use (Kelly et al., 1991, 1992). For example, a multicity trial that recruited popular gay men to educate other gay men who frequented bars resulted in a dramatic decline in the frequency of unprotected intercourse after several months (Kelly et al., 1992). Studies in Tanzania show that community-based interventions to improve syndromic management of