And while general educational efforts regarding what constitutes a ‘risky behaviour’ (e.g. unprotected anal sex) is a critical part of prevention efforts, understanding the factors that dispose people towards risky behaviours allows for targeted deployment of finite prevention resources. To that end, researchers and clinicians have been investigating a variety of predictors of sexual TRBs. Among behavioural and socio-demographic risk factors for sexual TRBs, substance abuse – especially Adriamycin order sildenafil [4–6], methamphetamine [7] and alcohol [8,9] abuse – appears to contribute to subsequent sexual TRBs separately

from the risk factors directly associated with IDU. Multiple partners [10], youth [11], sex trade GSK2126458 in vivo work [10] and limited education [12] also appear to be relevant factors. To complement these efforts, researchers and clinicians have also been examining a variety of psychological variables as potential predictors of propensity to engage in TRBs. The typical rationale is that if clinicians can, in combination with standard medical and psychiatric histories, use a relatively brief screener to identify those at greater risk of TRBs, then limited prevention resources can be directed towards those who will most benefit. Self-efficacy, treatment optimism or optimistic

attitude, perception of power within relationships [13] and supportive social norms [14,15] are all psychological variables associated with relatively low sexual TRBs. In terms of risk, depression [16], co-occurring severe mental illness and substance use [17], history of childhood sexual abuse [10], antisocial personality disorder [18] and psychological stress all have some supportive evidence as predictors of TRBs. Because providing good

medical care for cAMP persons living with HIV infection is already a challenge for time-constrained primary care providers, a lengthy sexual TRB assessment may take up time that providers do not have to spare. Following recommendations from the Centers for Disease Control and Prevention [19] and the Institute of Medicine [20], the Health Resources and Services Administration (HRSA) sponsored a 5-year initiative to develop and evaluate HIV prevention services in clinical settings. Fifteen sites received awards to tailor evidence-based prevention approaches to their settings and populations. Seattle was awarded one of the grants to conduct a 2-year, randomized controlled trial utilizing audio computer-assisted self interviews (ACASIs) to evaluate the effect of an intervention on TRBs over time. The intervention involved motivational interviewing and small group peer interventions conducted by a nurse specialist. The comparison group included patients who chose not to enrol or to delay enrolment in the intervention arm.