men. Some, therefore, tended to misperceive or distort the available public health information in ways that permitted them to appraise their behavior as less risky than it actually was. This has the dual effect of minimizing the anxiety that would result if they confronted their increased risk for AIDS due to their past behavior and permitting continuation of risky sexual practices that increase their risk of infection.
In our view, anxiety can be an important motivating force for practicing safer sex and protecting one's health. For this reason, we believe that, consistent with the tenets of the Fear-Drive Model and Dual-Process Model, moderate-fear health-education messages are probably necessary to motivate men to limit their practices to those considered safe. However, the cost of this strategy to gay men in terms of their psychological distress is high. We need to explore ways of helping gay men to successfully accomplish the difficult dual tasks of maintaining a level of anxiety sufficient to motivate safer-sex, while at the same time managing anxiety and maintaining psychological equilibrium.
Further, we need to explore the options for motivating behavioral change in men who use denial to manage anxiety at the expense of their health. Health messages regarding sexual practices may need to be more confrontational in order to reach men who are still practicing risky sex and to help them acknowledge that their practices are risky for AIDS. Our suggestion to score men's risk factors relative to other gay men and in terms of their absolute risks for AIDS may succeed in breaking through some men's denial. However, we expect that, in some cases, more intensive interventions would probably be necessary, in addition to written materials.
Models of preventive health behavior consistently emphasize that individuals must acknowledge that they are at risk before they will initiate and maintain preventive health practices. In this chapter, we have drawn attention to some of the mechanisms through which gay men may misperceive the risk. Although health education has apparently succeeded in communicating the facts about AIDS and how it is transmitted, additional strategies must be developed to help those at high risk to intergrate and apply these facts in ways that will successfully protect them from acquiring and/or transmitting AIDS.
This work was supported by grants from the National Institute of Mental Health (MH39441) and the New York State AIDS Institute (C000577).
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