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We are now nearing the end of the second decade of the AIDS epidemic. Although major advances in treatment have prolonged and improved the quality of life of those infected with HIV, there is still no cure for, or a vaccine to prevent, this deadly disease. Perhaps most important, it has become increasingly clear that primary prevention must focus on behavior and behavior change. AIDS is first and foremost a consequence of behavior. It is not who people are, but what people do that determines whether or not they expose themselves or others to HIV, the virus that causes AIDS. As Kelly, Murphy, Sikkema, and Kalichman (1993) pointed out, the task confronting the behavioral sciences is to develop theory-based intervention programs to reduce "risky" behaviors and increase "healthy" behaviors.

Although there are a number of theories of behavior and behavior change available in the literature, there are three theories that have had a major impact on much of the behavioral research in the AIDS area: the health belief model (e.g., Becker, 1974, 1988; Janz &Becker, 1984; Montgomery et al., 1989), social cognitive theory (e.g., Bandura, 1986, 1992, 1994) and the theory of reasoned action (e.g., Ajzen & Fishbein, 1980; Fishbein, 1980; Fishbein & Ajzen, 1975; Fishbein, Middlestadt, & Hitchcock, 1991).

According to the health belief model, two major factors influence the likelihood that a person will adopt a recommended health protective behavior. First, individuals must feel personally threatened by the disease (i.e., they must feel personally susceptible to a disease with serious or severe consequences). Second, they must believe the benefits of taking the preventive action outweigh the perceived barriers to (and/or costs of) preventive action.

From the perspective of social cognitive theory, the initiation and persistence of an adaptive behavior depends on beliefs of self-efficacy and outcome expectancies. That is, in order to perform a given behavior individuals must believe in their capability to perform the behavior in question under different circumstances and they must have an incentive to do so (i.e., expected positive outcomes of performing the behavior must outweigh expected negative outcomes). Incentives may involve physical outcomes, social outcomes, or self-sanctions.

According to the theory of reasoned action, performance or nonperformance of a given behavior is primarily a function of the person's intention to perform (or to not perform) that behavior. The intention is, in turn, viewed as a function of two primary determinants- the individual's attitude toward performing the behavior (based on their beliefs about the consequences of performing the behavior, i.e., beliefs about the costs and benefits of performing the behavior) and their perception of the social (or normative) pressure exerted on them to perform the behavior.

Early on, it became very clear that a distinction must be made between theories of behavioral prediction and theories of behavioral change. Whereas models of behavioral prediction focus on variables (or factors) that "determine" the performance or nonperformance of any behavior at a given point in time, models of behavior change focus on "states" of the organism or "stages" individuals may go through in their attempt to change behavior.

Generally speaking, there was agreement that people will continue to behave as they have in the past until some internal or external stimulus (e.g., a symptom, a mass media message) interrupts this "normal" flow of behavior. Behavioral prediction models attempt to identify variables that serve as determinants of ongoing behaviors. That is, these models focus on those variables that help to explain why some members of a given population are performing a given behavior while other members of the same population are not. In contrast, behavior change models focus first on the stimuli that "disrupt" ongoing behavior and then on the processes individuals may utilize in moving from one state or stage to another in their attempt to eliminate old or adopt new behaviors. . .

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