The cognitive interventions discussed above all rely on group formats for their delivery. This makes them labour intensive and unsuitable for large population interventions. However, a number of research teams have reported individual cognitive interventions which have proved effective.

Ron Gold reported a randomised controlled study using individual diaries to encourage men to examine their intentions and self–justifications regarding unprotected anal intercourse. Gay men were randomised to three groups and asked to keep a sexual diary for 16 weeks and send in completed pages each week. After four weeks men were radomised to one of three groups: a control group who received no intervention, a group who received safer sex posters with the request to evaluate their impact and effectiveness, and a group who were asked to fill in a questionnaire.

The questionnaire group were asked to reflect upon a recent occasion when they had engaged in unprotected anal intercourse, and were given a list of possible self–justifications for having unsafe sex. They were asked to indicate the extent to which each of these self–justifications had been on their mind at the moment they had decided to engage in unprotected anal intercourse. They were then asked to select the self–justifications that had been in their mind most strongly at the time; to indicate how reasonable each of these seemed to them now, looking back on it, an to briefly justify these responses. The men were thus asked to reflect on their thinking in the heat of the moment, and to justify it in the cold light of day.

A significant difference in sexual behaviour emerged by the end of the study period. Whilst there was no significant difference between the three groups in the numbers who had unprotected anal intercourse at least once, there was a significant difference between the self–justifications group and the others in terms of the amount of unprotected anal intercourse that took place during the 16- week study. 42% of the control group and 41% of the poster group had unprotected anal intercourse more than once, whereas only 17% of the self–justifications group had anal intercourse more than once.

Gold argues that the technique may exhibit a greater effect when individuals have unprotected sex after engaging in an examination of why they had unprotected sex. Presumably their first post–intervention slip–up provoked and disturbed the men; their perception that they had done it again concentrated their mind on the problem. At that point they really began to absorb the lessons of the intervention.

References

Gold R, et al: AIDS education: has it gone wrong? National AIDS Bulletin March, 1995.