Projects

  • China CPOL (Community Popular Opinion Leaders) Project

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served HIV Prevention, Community Leader HIV Transmission Reduction
    Geographic Scope International


    Project Type:

    Living with HIV
    NIMH Collaborative HIV/STD Prevention Trial
    This 8-year study was part of the National Institute of Mental Health (NIMH) Collaborative HIV/Sexually Transmitted Disease (STD) Prevention Trial in international settings, including China, India, Peru, Russia, and Zimbabwe. The trial was designed to identify, recruit, train, and engage community popular opinion leaders (C-POL) in a defined population to convey HIV risk reduction messages. The primary objective was to reduce HIV/STD incidence and risky sexual behaviors.

    Targeted Risk Group:
    Food Market Vendors
    Fuzhou, China

    Intervention model:
    Community Popular Opinion Leader (CPOL) HIV prevention intervention

    Research Methods:
    • Ethnographic studies to identify social networks
    • Pre-baseline assessment for risk estimates
    • 4,510 market workers from 40 food markets participated in the baseline
    • Behavioral and biological assessments
    • Longitudinal analyses with 12 and 24 month follow-ups

    Local Significance:
    The project has provided an opportunity to communicate with policy makers at all administrative levels in China about HIV prevention and intervention strategies. The POL model was adapted by other intervention studies in China.

    International Significance:
    This is the first test of the efficacy of a similar intervention in multiple international sites. China is the first of the five countries that has begun the baseline assessment and intervention activities. More than 15 peer-reviewed papers have been published.

     

  • CLEAR: Choosing Life: Empowerment, Actions, Results

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, HIV Prevention
    Geographic Scope National


    Project Type:
    Living with HIV

    Choosing Life: Empowerment, Action, Results! (CLEAR) for Comprehensive Risk Counseling and Services (CRCS)

    CLEAR-CRCS is an evidence based HIV prevention and health promotion intervention developed for people living with HIV enrolled in Comprehensive Risk Counseling and Services (CRCS). It is a client-centered program delivered one-on-one with clients who are having difficulty initiating or sustaining behaviors that prevent HIV transmission and reinfection. The program teaches clients cognitive-behavioral strategies to cope with triggers and other stressful situations that lead to risky behaviors and unhealthy choices. The goal of CLEAR-CRCS is to help these people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. CLEAR-CRCS is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

    CLEAR-CRCS is structured such that the CRCS provider can individually tailor the program to address the unique needs of each client. The program consists of six foundational sessions that teach the core behavioral strategies of the program. Within these initial sessions, the client also develops a personal life goal and his or her prevention plan which will direct the focus of subsequent sessions. The provider then has a menu of 21 sessions to choose from in which the client can practice and apply the core strategies to realize his or her goals. The sessions in the menu address five domains: sexual behavior, substance use, treatment adherence, mental health, and successful disclosures.

    Research on the original CLEAR Intervention: The original CLEAR study was conducted from 1999-2003 with an ethnically and culturally diverse group of substance using young people living with HIV/AIDS. The intervention was conducted as a multi-site trial in Los Angeles, San Francisco, and New York. The study demonstrated a significant increase in protected sexual acts, such as using condoms, with all partners and with HIV-negative partners.

    Underlying Theory and Principles: The intervention was developed based on the social action theory. Social action theory stresses the importance of social interactions and environmental factors in a person’s ability to control behaviors that may endanger his or her health. It incorporates the principles that are expressed in traditional social-cognitive models of health-behavior change, including social-cognitive theory, the health belief model, and the transtheoretical model (stages of change). CLEAR-CRCS is predicated on the notion that behavior change depends both on a person’s belief that he or she can change a behavior (self-efficacy) and the beliefs that changing the behavior will result in a desired outcome (response efficacy).

    Targeted Risk Group:
    Original efficacy trial: Young People Living with HIV (YPLH) aged 16-29. In CDC dissemination through CRCS the target population also include high-risk HIV-negative persons and ages 16 or above (so not restricted to young adults).

    Research Methods:
    Randomized Controlled Trial. Individuals randomly assigned to immediate intervention or a delayed (waitlisted) control group and completed assessment interviews every three months for 15 months.

    Local Significance:
    Participants reduced substance use and sexual risk behaviors.

    Intervention model:
    Individual level intervention
    Original efficacy trial tested in-person delivery (more efficacious) and telephone delivery.

  • Community Healthy Study

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Other
    Geographic Scope Local


    There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population.
    Understanding the HIV epidemic in Los Angeles requires establishing an integrated, multilevel surveillance system for HIV, sexually transmitted diseases (STDs), and the Hepatitis C virus (HCV). Information about sexual and substance use risk behaviors, HIV seroprevalence, and public knowledge, attitudes, and norms regarding HIV are needed for public health planning. A surveillance system will be required in order for Los Angeles to maintain funding for Ryan White and other federal and state funding sources. To begin to develop a method for mounting a comprehensive surveillance system, the City of Los Angeles is planning a study examining the acceptability of anonymous HIV testing and volunteering information about one’s risk behaviors in order to allow planning for HIV-related services.

    Most studies of HIV seroprevalence and risk behaviors have been conducted with subgroups identified at high risk for HIV: young gay men, injecting drug users, homeless adolescents, or seriously mentally ill adults. There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population (not necessarily from identified high-risk groups). Before any comprehensive surveillance system can be established, the ability to monitor HIV in community settings and among households in neighborhoods with high rates of AIDS cases must be established. To fill this gap, a two-phase project is being initiated by the city in order to assess the acceptability of HIV testing and reporting one’s risk behaviors when approached: 1) in a household survey; or 2) in a neighborhood setting such as a shopping mall, grocery center, theater, or church.

    First, the acceptability of gathering HIV-related information from a household will be examined by conducting a supplement to the Los Angeles Health Survey that will be mounted this summer. An anonymous telephone interview will be conducted with random digit dialing of households within the City of Los Angeles. Randomly selected telephone numbers (n=100) will be surveyed on knowledge of transmission of HIV, attitudes and norms towards members of high-risk groups (e.g., gay men) and infected persons, and willingness to anonymously be tested for HIV. All responses will be recorded unlinked from telephone numbers selected by random digit dialing; therefore the identify of all respondents will be unknown and can never be traced. From gathering this information, the acceptability of a household approach as a method of gathering information about HIV-related information will be assessed.

    Second, a community with a high rate of AIDS cases will be selected. In this neighborhood, local leaders will be consulted to identify a strategy for sampling community members anonymously and in settings accessible to all community members. In shopping malls in both communities, adults will be asked to anonymously volunteer to participate in a survey of attitudes and norms regarding HIV prevention activities, recent sexual and substance use risks acts, and consent to a saliva-based HIV test. The results of any individual test results will not be available; unmarked samples will be collected in order to indicate a community seroprevalence rate. Interested individuals will be offered an incentive for participating in the survey and test. The willingness of adult members of the community to participate in a study anonymously will be evaluated. Similar to the telephone household survey, no identity of any participant will be obtained. Overall, community rates will be obtained, but no individual information regarding risk or infection status.

    The results of these two activities will be used to inform the Los Angeles County Board of Supervisor’s decisions regarding the best method for establishing surveillance methods for HIV infection and predictions regarding the future routes and subgroups for HIV infection. Currently, the County is considering adopting a method of practitioners informing public health officials of all persons testing seropositive for HIV or for a system of unique identifiers for persons who test seropositive for HIV. Both of these systems rely on the identification of seropositive persons, an event that typically occurs about 10 years after a person has become infected. Alternative strategies for monitoring the epidemic, especially among communities with an emerging epidemic must be identified. These studies will inform the strategy selected by the County and may become a national model.

  • Economic Evaluations for HIV Prevention Programs for Adolescents

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Youth and Adolescents, At Risk, HIV Prevention
    Geographic Scope Local

    Project Name:
    Economic – Economic Evaluations for HIV Prevention Programs for Adolescents

    Project Type:
    While the field of HIV prevention has demonstrated that adolescents do reduce their sexual and substance use risk acts in response to intervention programs, there have been no evaluations of the cost effectiveness of these program.
    Effective HIV preventive interventions have been developed and evaluated with adolescents (Jemmott, in press). CHIPTS investigators designed, mounted, and evaluated HIV prevention programs with four adolescent samples at high risk for HIV: runaway youth (n=312), gay youth (n=154), youth living with HIV (n=351), and youth with parents with AIDS (n=423 adolescents from 280 different families). Each of these samples reflects a sub-population at high risk of contracting or transmitting HIV; each is composed predominantly of African-American and Latino youth aged 12-20 years. For each population, an intervention was designed based on social learning theory that focused primarily on skill building and aimed at reducing sexual and substance use risk acts; each intervention also was tailored for the specific population. Each intervention was delivered in a small group setting, used tokens to encourage social rewards, and monitored affect by the use of a feeling thermometer. Homework assignments were common across interventions and multiple sessions were implemented. Each sample has been followed for at least two years; the assessment points for follow-up were at least 3, 6, 12, 18, and 24 months. The same research team designed the measures and the domains of assessment were similar. Each sample was assessed for sex and drug use.

    While the field of HIV prevention has demonstrated that adolescents do reduce their sexual and substance use risk acts in response to intervention programs, there have been no evaluations of the cost effectiveness of these programs. This project, funded by the National Institute of Mental Health (NIMH), will evaluate the cost-effectiveness of each of the four adolescent prevention programs already mounted and compare the consistency of the cost-effectiveness findings across studies. The project consists of three phases. First, building on a cost-effectiveness analysis of the HIV intervention on runaway youth, this project is using the existing data to perform the cost-effectiveness analysis of the other three HIV intervention programs which were delivered to adolescents (youth living with HIV, gay youth, and youth whose parents living with AIDS). Second, the results of these four cost-effectiveness analyses are being used to examine the similarity and the consistency of the cost-effectiveness of different HIV-related intervention programs. Third, because HIV sex risk acts among adolescents are usually part of a cluster of problem behaviors, this project will expand current strategies for examining cost-effectiveness to include social outcomes such as foster care, mental health institutionalization, jail, and temporary shelter.

     

  • Grief Interventions for PLAs, Adolescents and Guardians

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, Youth and Adolescents, Families
    Geographic Scope Local

    Project Name:
    Grief Interventions for PLAs, Adolescents and Guardians

    Project Type:
    Living with HIV
    Grief Interventions for PLAs, Adolescents and Guardians

    Project Description:
    By the year two thousand, 80,000 children will be orphaned by AIDS in the U.S. and this number will continue to rise. Parental death during one’s childhood has been consistently associated with negative outcomes for children, however, there have been no prospective studies of adolescent bereavement from any type of parental death, including death from AIDS. This continuation study is aimed at delivering and evaluating an intervention to alleviate grief associated with the death of a parent. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 US adolescents bereaved annually by parental death.

    Scope:
    Over the last two and a half years, 310 parents living with AIDS (PLAs) and their 498 adolescent children, age 12-18 were recruited. They were randomly assigned to receive: (1) a standard care condition in which extensive social welfare services are provided; or (2) an enhanced care condition in which three modules of coping skills intervention (Project TALC: Teens and Adults Learning to Communicate) plus social services are provided. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are schedule to meet individually and jointly in over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last two years, about two thirds of the sample of PLAs continue to live longer than anticipated, delaying the delivery of the final intervention module. Over the next 18 months, the investigator anticipates that the PLAs will die, and the final, post-death module of the intervention will be delivered. The present continuation study will allow the investigator to complete the delivery and the evaluation of the intervention, and in addition, pursue the following activities: (1) follow youths of PLAs prospectively and longitudinally for four additional years to evaluate their mental health, behavioral, and social outcomes; (2) complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; and (3) develop new measures of grief to describe the bereavement process over time.

    Parents living with AIDS reported a mean of 3.3 (SD=1.3) areas of conflict with their adolescents and 1.5 (SD=1.7) stressful parenting events over the previous three months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use: stressful parent events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African-American parents, but not white parents. In contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents’ health status, but were significantly influenced by substance use and sexual lifestyles. Both mothers (87%) and fathers were significantly more likely to disclose their serostatus to adolescents (73%), compared to younger children (23%). Only 44% disclosed to all their children; 11% disclosed to none. Most PLAs (80%) discussed custody plans; however, only 30% initiated legal plans, typically for younger children. Adolescents informed of their PLA’s serostatus engaged in more sexual risk acts, smoked more cigarettes, reported more severe substance use, and greater emotional distress than did uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or followup.

    National Institute of Mental Health, grant 2R01MH49958-06

    Targeted Risk Group:
    AIDS-infected parents and their children

     

  • Healthy Living Project (HLP): Multi-Institutional Collaborative Research Project

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, HIV Prevention, At Risk
    Geographic Scope National

    Project Name:
    Healthy Living Project (HLP): Multi-Institutional Collaborative Research Project

    Project Type:
    Living with HIV

    Reducing HIV-related transmission acts among PLH.

    The UCLA Healthy Living Project was funded by the National Institute of Mental Health (NIMH) and was designed to promote health-related behavior changes in adults living with HIV. This project aimed to reduce sexual and injection drug use risk behaviors among 1,200 HIV positive men and women in order to decrease the likelihood of secondary HIV transmission. The research study focused on four subgroups: women, heterosexual men, men who have sex with men, and injection drug users. The study was conducted at four sites: Los Angeles, Milwaukee, New York, and San Francisco.

    Targeted Risk Group:
    Adults living with HIV

     

  • Interventions for Substance-Using Youth Living with HIV

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served HIV Prevention, Community Leader HIV Transmission Reduction
    Geographic Scope National

    Project Name:
    Interventions for Substance Using Youth Living with HIV

    Project Type:
    Living with HIV
    Substance Abuse
    Interventions for Substance Using Youth Living with HIV

    Project Description:
    Increasing numbers of youth are infected with HIV and are confronted with a series of challenges: stopping HIV transmission to others, maintaining health care regimens, improving their quality of life. Over the last 4 years, an intensive 31-session, 3-module intervention was designed, implemented, and evaluated to help youth living with HIV (YLH) meet these challenges. YLH significantly changed behaviors; however, a restructuring of the intervention is required based on new information from our previous study and new scientific breakthroughs: 1) only 30% of YLH continue their substance use and sex risk after learning they are seropositive 2) 30% of YLH never attended any group session, and 3) the recent scientific advances in HIV require addressing beliefs regarding post-exposure prophylaxis, life expectancies, undetectable viral loads, and the role of substance use in adhering to new medical regimens.Therefore, building on the positive results of the previous study, a secondary prevention program, CLEAR (Changing Lifestyles: Effort And Rewards) will be evaluated over 21 months for 200 substance-using YLH (aged 13-23) in Miami and LA. In addition, we will examine I) how YLH’s substance use influences seeking and adhering to combination antiretroviral therapies,and youth’s reinitiation of transmission acts based on their viral loads, beliefs regarding transmissivity of undetectableviral loads, as well as beliefs in post-exposureprophylaxis and life expectancies; 2) how well the components of the Social Action Model predict reductions insubstance use, sexual behaviors, relapse, improvements in health adherence,acquisition of knowledge of the program, and quality of life (3) the cost effectiveness of delivering the prevention program to YLH, as well as monitoring costs for health utilization for medical, nonmedical services, and differential benefits of telephone groups, individual sessions, and small groups (from previous study).

    Scope:
    The youth will be randomly assigned to a 3-module intervention (totaling 18 sessions)that is delivered in either a)anonymous telephone groups or b) individual sessions. Based on the Social Action Model, the intervention will 1) in Module 1, reduce substance use sexual behaviors that may transmit or enhance transmission of the HIV virus. 2) in Module 2, reduce the negative impacts of substance use on seeking and utilizing healthcare, and increase assertiveness and adherence to health regimens. 3) In Module 3, enhance quality of life and self-actualization in order to maintain behavior changes over time.
    National Institute on Drug Abuse, Grant 5R01DA07903-08

  • Interventions for Substance-Using Youth Living with HIV

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, Substance Abuse, Youth and Adolescents
    Geographic Scope National

    Project Name:
    Interventions for Substance Using Youth Living with HIV

    Project Type:
    Living with HIV
    Substance Abuse
    Interventions for Substance Using Youth Living with HIV

    Project Description:
    Increasing numbers of youth are infected with HIV and are confronted with a series of challenges: stopping HIV transmission to others, maintaining health care regimens, improving their quality of life. Over the last 4 years, an intensive 31-session, 3-module intervention was designed, implemented, and evaluated to help youth living with HIV (YLH) meet these challenges. YLH significantly changed behaviors; however, a restructuring of the intervention is required based on new information from our previous study and new scientific breakthroughs: 1) only 30% of YLH continue their substance use and sex risk after learning they are seropositive 2) 30% of YLH never attended any group session, and 3) the recent scientific advances in HIV require addressing beliefs regarding post-exposure prophylaxis, life expectancies, undetectable viral loads, and the role of substance use in adhering to new medical regimens.Therefore, building on the positive results of the previous study, a secondary prevention program, CLEAR (Changing Lifestyles: Effort And Rewards) will be evaluated over 21 months for 200 substance-using YLH (aged 13-23) in Miami and LA. In addition, we will examine I) how YLH’s substance use influences seeking and adhering to combination antiretroviral therapies,and youth’s reinitiation of transmission acts based on their viral loads, beliefs regarding transmissivity of undetectableviral loads, as well as beliefs in post-exposureprophylaxis and life expectancies; 2) how well the components of the Social Action Model predict reductions insubstance use, sexual behaviors, relapse, improvements in health adherence,acquisition of knowledge of the program, and quality of life (3) the cost effectiveness of delivering the prevention program to YLH, as well as monitoring costs for health utilization for medical, nonmedical services, and differential benefits of telephone groups, individual sessions, and small groups (from previous study).

    Scope:
    The youth will be randomly assigned to a 3-module intervention (totaling 18 sessions)that is delivered in either a)anonymous telephone groups or b) individual sessions. Based on the Social Action Model, the intervention will 1) in Module 1, reduce substance use sexual behaviors that may transmit or enhance transmission of the HIV virus. 2) in Module 2, reduce the negative impacts of substance use on seeking and utilizing healthcare, and increase assertiveness and adherence to health regimens. 3) In Module 3, enhance quality of life and self-actualization in order to maintain behavior changes over time.
    National Institute on Drug Abuse, Grant 5R01DA07903-08

  • Mamekhaya

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Population Served Women, Living with HIV
    Geographic Scope International

    Project Name:
    Mamekhaya
    Project Type:
    Living with HIV
    Mamekhaya

    In South Africa, where a large portion of pregnant women are HIV positive, prevention of mother-to-child transmission of HIV (PMTCT) is an important endeavor. To improve the effectiveness of the standard PMTCT programs, the Mamekhaya program used peer mentoring and a culturally adapted cognitive behavioral intervention (CBI).

    Targeted Risk Group:
    HIV-positive pregnant women

    Research Methods:
    HIV-positive pregnant women at the Gugulethu Midwife Obstetric Unit and at the Vanguard Community Health Center in Cape Town were invited to participate in the study. Participants at both sites received the standard PMTCT care; however, participants at the Gugulethu site received the Mamekhaya intervention.The first part of the intervention consisted of assigning a participant with a mentor mother through Mothers2mothers. The mentor mother was a woman who was HIV-positive, had recently had a child, and had received PMTCT and was doing well. Participants also attended group sessions of a cognitive-behavioral intervention. The sessions included information on living with HIV, preventing HIV transmission, parenting, social support, and mental health.

    Local Significance:
    Participants in the Mamekhaya intervention had increased HIV knowledge scores, significantly increased social support, and significantly decreased depression scores compared to women in the control group.

  • Masihambisane- KZN

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, Women, Substance Abuse, Comorbidities
    Geographic Scope International

    Project Name:
    Masihambisane – Pregnant Women: KZN

    Project Type:
    Living with HIV

    HIV, TB, and Alcohol Prevention Amongst Pregnant Women

    There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Since clinics are the typical sites for treating each of these health problems, the NIMH-funded Masihambisane study is examining a clinic-based prevention program delivered by neighborhood Mentor Mothers (MM) to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

    Targeted Risk Group:
    Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

  • MD for Life: Making Decisions for Life

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Norweeta Milburn
    Population Served HIV Care, Living with HIV
    Geographic Scope National

    Project Name:
    MD for Life: Making Decisions for Life

    Project Type:
    Living with HIV

    Help health-care professionals and researchers learn how well an intervention works with people living with HIV.

    MD for Life is a study that will help health-care professionals and researchers learn how well an intervention works with people living with HIV. Funded by the University-wide AIDS Research Program, the intervention is designed to reduce sexual risk and substance behavior by increasing motivation and intention for behavior change among individuals living with HIV. The intervention will be delivered in two different modalities. The first intervention delivery strategy will have a health care professional, trained in counseling techniques, talk with patients about their sexual and substance use risk behaviors. The second delivery strategy will have the patient receive the counseling via an interactive and engaging computer program. The counseling is based on a proven technique called motivational interviewing. This counseling technique has been successful in reducing alcohol use in multiple populations. A total of 400 patients are being recruited from four health clinics (100 patients from each clinic) that primarily serve individuals living with HIV.

    While other HIV prevention programs have been successful, they have been expensive, needed multiple small group sessions, and required coordination of many schedules and extensive training for staff. This project builds on previous prevention successes and utilizes existing staff, treatment delivery settings, and new technology to deliver a brief innovative intervention that can be repeatedly delivered to a diverse population of individuals living with HIV. If successful, this program would be an inexpensive and fairly effortless program to implement in health clinics nationwide.

  • Nsindikanjake Vocational Training Project

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served At Risk, Youth and Adolescents
    Geographic Scope International

    Project Name:
    Nsindikanjake Vocational Training Project

    Project Type:
    Substance Abuse
    Other
    Nsindikanjake Vocational Training Project

    Socio-economic status plays an important role in HIV risk and prevention. Specifically, poverty can lead to survival sex and unprotected sex. The Nsindikanjake Vocational Training Project, a collaboration between UCLA and the Uganda Youth Development League (UYDEL), aims to reduce HIV risk among urban Ugandan youth through vocational education and training.

    Targeted Risk Group:
    Urban Ugandan Youth

    Research Methods:
    From February 2005 to January 2006, 100 13- to 23-year-old participants were recruited from two different youth centers in the slums of Kampala, Uganda. Youth were randomized by site to an immediate vocational training intervention (N=50 youth) or a 4-month delayed vocational training (N=50 youth). Participants were assessed at baseline, 4, and 24 months later. Youth were asked about employment, sexual risk behaviors, delinquent behavior, quality of life, mental health symptoms, and drug use.Vocational education consisted of apprenticeships with local artisans for 4 to 8 hours, 5 days a week. Artisans received training in having conversations with youth about HIV and how to cope with unprofessional behavior (e.g., tardiness, hygiene problems). Youth in the delayed training condition received vocational training after a 4-month follow-up assessment was completed. The final assessment was administered 24 months after enrollment, by which time all youth had received training.

    Local Significance:
    Vocational training may be highly useful in supporting the impact of HIV prevention. The participants receiving vocational training showed reduced delinquent behaviors and greater improvements in employment, life satisfaction, and social support compared to control participants . Both conditions demonstrated such improvements at two years, especially ongoing employment which remained strong.

  • Philani- Cape Town

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, Women, Substance Abuse, Comorbidities
    Geographic Scope International

    Project Name:
    Philani (Pregnant Women: Cape Town)

    Project Type:
    Living with HIV
    HIV, TB, and Alcohol Prevention for Pregnant Women

    There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Furthermore, while clinics are the typical sites for treating each of these health problems, the NIAAA-funded Philani study is examining a home-visiting prevention program delivered by neighborhood Mentor Mothers (MM) as an alternative to clinic-based interventions to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for the next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

    Targeted Risk Group:
    Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

  • Popular Opinion Leader HIV Intervention among Chinese Market Workers

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served HIV Prevention, Sexually Active Adults
    Geographic Scope International

    Project Name:
    Popular Opinion Leader HIV Intervention among Chinese Market Workers

    Project Type:
    Other
    Popular Opinion Leader HIV Intervention among Chinese Market Workers
    This project is part of the NIMH Collaborative HIV/STD Prevention Trial which adopts a two-arm, randomized community-level design to test the Popular Opinion Leader (POL) HIV prevention intervention model at five international sites (China, India, Peru, Russia, and Zimbabwe). CCH is the lead on the China site.

    China, representing 1/4th of the world’s population, has a rapidly emerging HIV epidemic with about 1.2 million individuals already infected, more than the total of all the Asian nations combined. Similar to Africa and India, the country’s 200-250 million labor migrants are a key to the epidemic’s future; however, HIV infection is predominantly occurring in rural settings (75% of population) and migrants transmit the virus heterosexually when moving to the cities annually.

    The goals of this project are: 1) to adapt a comprehensive community-level preventive intervention – The Popular Opinion Leader – to populations in China based on data from ethnographic studies and compare the results with the other four international sites which follow the same research procedure; 2) to test the efficacy of this community-level preventive intervention in China as well as the four international sites utilizing both behavioral and biological outcomes; and, 3) to develop a manual that will permit different health care agencies and service providers to conduct rapid ethnographic studies, translate this community-level intervention to different settings and populations, and assess intervention efficacy.

    The ability of CCH investigators to successfully implement the project is based on previous successful HIV prevention trials including interventions in China and participation in HIV-related cooperative agreements; support of the project from experienced Chinese collaborators, officials, and organizations; access to sites in China; collaboration with experienced Chinese investigators, several of whom have trained at UCLA; collaboration of the Qualitative Core of the UCLA-NPI with considerable cross-national and cross-site experience; and previous experience in conducting interventions and assessments that are culturally sensitive and appropriate.

  • Project i (Prevention Among Homeless Youth)

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Homelessness, Youth and Adolescents, At Risk
    Geographic Scope International

    Project Name:
    Project i

    Project Type:
    Homelessness

    Understand the life course of new homeless youth and runaways in Los Angeles County and Melbourne, Australia.

    A number of studies have informed us about the substantial risk for HIV associated with chronic homelessness among youth in both the U.S. and Australia, even though these studies have typically been cross-sectional or samples of convenience. To understand the high seroprevalence rates among older homeless youth, the developmental trajectories into and out of risk for HIV and homelessness can best be understood from longitudinal studies of first time runaways, in which contextual factors (the national, community supports, street experiences, peers, and family) that influence these trajectories can be identified and observed over time.

    The National Institute of Mental Health (NIMH) funds this study of new homeless young people. The purpose of the study is to understand the life course of new homeless youth and runaways. The study focuses on the many sources that are influencing youths pathways into and out of homelessness and risk for HIV, such as a youth’s family background, individual characteristics, personal resources, street experiences, peer social networks, interactions with social service providers, and informal support systems.

    PROJECT i is following new homeless youth over time to see if they become more similar or dissimilar to experienced homeless youth. We know that among homeless youth, remaining homeless may only serve to increase their risk for HIV. This suggests a critical need to find ways to divert new homeless youth from the path of chronic homelessness and greater risk for HIV infection. The results of the study will be used to design interventions for new homeless youth to reduce their risk for HIV and to help inform service providers who may influence the life course of runaways and homeless youth and as a result help decrease their risk for HIV and becoming chronically homeless.

    Approximately 240 youth, ages 12 to 20 years, are being recruited throughout various parts of Los Angeles County. A similar sample is being recruited in Melbourne, Australia. Youth who report having left home no more 180 days are eligible to participate in the study. An additional 200 youth per year, ages 12 to 20 years, who report having left the home for more than 180 days and who do not meet the above criteria, are eligible to participate in a one-time interview as part of a comparison group.

    Following a baseline interview, study participants are interviewed at three months and then every six months for a total of eight interviews over a three-year period. Interviews take approximately one hour to complete. The baseline interview is conducted at the shelter or center where the youth was recruited. Follow-up interviews are conducted at a place convenient for the youth.

  • Safety Counts

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Substance Abuse, At Risk, HIV Prevention
    Geographic Scope Local

    Project Name:
    Safety Counts

    Project Type:
    Substance Abuse

    Drug users have a high risk of HIV infection. Because certain neighborhoods have higher levels of substance abuse, HIV risk becomes related to geography as well. Thus, there is need for local street outreach programs, such as Safety Counts.

    Targeted Risk Group:
    Injection drug users, crack cocaine users


    Research Methods:

    In a quasi experimental, cross-over design, two Los Angeles neighborhoods were randomly assigned to receive either (1) Voluntary HIV Counseling and Testing (VCT) or (2) Safety Counts. In Phase 1, injection drug users and crack users in these neighborhoods attended the respective intervention. In Phase 2, each neighborhood and therefore its participants received the alternative intervention. Participants were reassessed at 5–9 months. Data collected included demographics, sexual risk behavior, and substance abuse.The Safety Counts intervention differed from the VCT intervention in that Safety Counts offered skill-building and goal-setting workshops, one-on-one counseling sessions to implement goals, street contacts to support other participants, and social events.

    Local Significance:
    Drug users in the Safety Counts program reported significantly greater reductions in risky sex, crack and hard drug use, and risky drug injection. The more sessions of Safety Counts attended, the greater were the reductions in risky acts. Different analytic decisions result in very different findings for the same intervention. Safety Counts is an effective intervention for injection drug users and crack users.

  • Street Smart Uganda; UYDEL

    At a glance:

    Status Completed
    Principal Investigator Marguerita Lightfoot
    Current Contact Mary Jane Rotheram
    Population Served Homelessness, Youth and Adolescents, Slums, At Risk
    Geographic Scope International

     

    Project Type:
    Homelessness
    HIV/AIDS Intervention for Slum Youth

    Targeted Risk Group:
    Urban Ugandan youth (UYDEL)

    Street Smart was an intensive HIV/AIDS program for slum youths whose behaviors place them at risk of becoming HIV infected. It was implemented in collaboration with Uganda Youth Development Link.

    Based on the fact that adolescence is a time of experimentation and developmental change in behavior, thoughts and emotions, Street Smart linked feelings, thoughts, emotions and attitudes to behavior change.

    In 2007, nearly 1 million young people became infected with HIV in sub-Saharan Africa. Existing prevention programs have not been effective, prompting more attention toward the social determinants of HIV, such as unemployment. Without hope for the future, it is unlikely that young people will be motivated to remain free of HIV, as poverty creates vulnerability to survival sex or sex without condoms. The Street Smart intervention was developed in the United States to eliminate or reduce HIV risk behaviors among young people. Despite its success, it does not address the problems of economic vulnerability and investment in the future. The aim of this study was to test the added value of vocational training provided to urban Ugandan youth, in addition to the Street Smart HIV prevention program.

  • Structural Pathways for South African Men to Reduce Substance Abuse and HIV

    At a glance:

    Status Active
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Substance Abuse
    Geographic Scope International

    Project Summary:
    Young men aged 18-25 years in South Africa face the intersecting epidemics of HIV, alcohol and drug abuse, and unemployment. This R34 is designed to reduce young men’s risk by addressing three problems with existing evidence-based programs (EBP): interventions are not designed considering men’s fight-flight coping strategy; donors are unwilling to invest in substance abusing men; and existing job training does not consider young men’s poor habits. Our goal is to apply behavioral economists’ strategies to new delivery formats that are highly attractive to young men: soccer and job training. A neighborhood-level HIV prevention strategy will shape men’s positive daily routines at an organized soccer league: being on time, completing practice, arriving sober & drug free, showing sportsmanship, and being nonviolent. Employment training by artisan trainers/mentors will be contingently offered to young men who demonstrate positive habits-of-daily-living on 80% of days over two months. Young township men in two neighborhoods will be randomized to receive the intervention that includes soccer, job training, and contingency management to shape behaviors (N=1 neighborhood; n=60 males) or to receive the control condition of soccer and job training without contingency management (n=1 neighborhood; 60 males).

    Assessments will be at baseline and 6 months follow-up. We hypothesize the program will significantly reduce HIV-related sexual risk acts and substance abuse, and sustain more employment. We will evaluate life goals, consistency of daily routines pro-social acts, & family relationships. We will primarily evaluate intervention feasibility and uptake, and preliminarily evaluate intervention impacts and mediating factors for reducing HIV risk acts & substance use. We will also document stakeholders’ perceptions of the program’s challenges and successes via Key informant interviews, the number of young men in shebeens over time via observations, and the key features of the social movement strategies of the Sonke Gender Justice, a men’s advocacy movement.

    HIV prevention efforts for young people in Sub-Saharan Africa have largely been unsuccessful: novel, structural, community level programs that address the social determinants of HIV are needed (Fenton, 2010; NIAID, 2010; Gupta et al., 2008). In particular, young South African men face many barriers, relative to women, to access and utilize HIV prevention programs, including that:

    Young men are more likely to have concurrent sexual partners, abuse multiple substances, drop-outof school, and be unemployed, compared to women, creating greater challenges for behavior change(Kalichman et al., 2009; Wechsberg et al., 2008).
    Many donor agencies are only willing to invest in women (Pronyk et al., 2007; Yunus, 2003). Men havegreater interpersonal power, are considered to be substance abusers who squander money and unreliable employees, making interventions difficult (Khandker, 2005; Wong et al., 2008).
    Existing prevention programs are more consistent with women’s coping styles “to tend and befriend” (Taylor, 2002). Men’s coping style of fight-flight (Tyrell, 2002) is less compatible with HIV’s current arsenal of evidence-based interventions (EBI) and microfinance program support groups (Kuhanen, 2009). Men are unlikely to attend stigmatized counseling sessions, typical of EBI (Peterson, 2007).
    The existing R3 billion spent on government job training programs in South Africa (i.e., SETA) deliver didactic lessons. Fewer than 0.9% get on-the-job training or graduate (Bennel & Segrestom, 1998; Akojee & McGrath, 2007; Ziderman, 2003). High demand for relatively low skilled labor is filled by immigrants from neighboring African countries, rather than South Africans, leading to high unemployment and civil unrest.
    This R34 aims to design a structural, community-level intervention to sustain self-protective acts among young, South African men aged 18-25 years. A two-pronged intervention is planned to acquire skills-of-daily- living (through soccer) and job skills (through artisan apprenticeships). Over two years, we will demonstrate the feasibility, acceptability, and uptake of the intervention components and outcome measures. We aim to shift four behaviors of young men: to increase consistent habits-of-daily-living, provide job skills and to decrease substance use and HIV-related sexual risk. Young men will be invited to play soccer daily, with contingency management in one neighborhood and not in another neighborhood. If youth are adherent to the program, they will be offered on-the-job-training and receive artisan tools at graduation.

    We will proceed in two phases:
    In Phase 1, qualitative interviews will elicit information on men’s developmental pathways. Sonke Gender Justice, a South African NGO advocating for men’s mobilization for gender equity and respect for women, will recruit and train coaches for a daily soccer program and Artisans to deliver a job training program. While soccer is intrinsically rewarding, this pilot will evaluate whether a strategy of behavioral economists (i.e., contingency management) is needed to ensure high program uptake to shape four daily routines: showing up on time, sober & drug free, completing practice, and showing sportsmanship. Coaches will not be counselors or provided with specific scripts, but will be trained in the Street Smart EBI to learn the core intervention tools to problem solve challenges of daily living; create opportunities to dramatically demonstrate key health principles; to form solid bonds with young men; and to be knowledgeable about health risks and community resources. The artisan trainers will be local entrepreneurs making an income, who will receive training and support on how to mentor youth. Artisans will be supported to shape youth’s job behaviors, similar to our successful Uganda program (Rotheram-Borus et al., 2010; Lightfoot et al., 2009).

    In Phase 2, a quasi-experimental design with two neighborhoods will be implemented. Neighborhoods have been matched on size, type and quality of housing, number of shebeens (bars), and length of residence. All young men aged 18-25 years in each neighborhood will be recruited to participate in a baseline interview (n=60/neighborhood). One neighborhood will be randomized to the Contingency Management Condition (CMC; n=60 youth) and one to the Control Condition (CC; N=60 youth) and reassessed at 6 months. Coaches will implement the soccer program in both neighborhoods; youth demonstrating consistent habits at soccer for at least two months will be offered access to four months of artisan training. Stakeholder interviews (n=10 at baseline and end of program in each neighborhood) and observations at local shebeens (n= 2/month @ 5 shebeens per neighborhood) will also be conducted to monitor community-level changes over time.

    The specific aims of this project are:
    1. To describe perceived challenges of emerging adulthood among young men; and to document perceptions of the program’s challenges and successes, and the key features of the social movement strategies of the Sonke Gender Justice NGO partner that are associated with men’s successes.
    2. To document the program uptake, adherence, prosocial acts, and substance free days in CM vs no-CM.
    3. To examine if young men in the CM vs. no-CM control condition demonstrate significantly:
    a. Fewer HIV-related sexual risk acts, less substance use, and more employment;
    b. More positive life goals; consistent, healthy daily routines; & greater social support & prosocial acts.
    c. To contrast the number of men in shebeens and clean substance use screens across conditions.

  • Teens and Adults Learning to Communicate (TALC: LA)

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served HIV Prevention, Community Leader HIV Transmission Reduction
    Geographic Scope Local

    Project Type:
    Living with HIV
    Teens and Adults Learning to Communicate

    Project TALC was funded by the National Institute of Mental Health (NIMH) to evaluate the efficacy of a family-based intervention over time and to contrast the life adjustments of HIV-affected families and their non-HIV-affected neighbors in the current treatment era. Mothers living with HIV (MLH; n = 339) and their school-age children (n = 259) were randomly assigned to receive a behavioral intervention or standard care as the control condition. MLH and their children were compared to non-HIV-affected families recruited at neighborhood shopping markets.

    Targeted Risk Group:
    HIV-positive mothers and their adolescent children

    Intervention Model:
    Mothers and their adolescents attended a 16-session cognitive behavioral intervention over eight weeks. For MLH, intervention goals aimed to: 1) improve parenting while ill (i.e., reduce family conflict, improve communication, clarify family roles); 2) reduce mental health symptoms; 3) reduce sexual and drug transmission acts; and 4) increase medical adherence and assertiveness with medical providers. For adolescents, the intervention goals were to: 1) improve family relationships; 2) reduce mental health symptoms; 3) reduce multiple problem behaviors (e.g., drug use, criminal justice acts, school problems, teenage pregnancy); and 4) school retention.

    Research Methods:
    In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Both intervention and control families were compared to a neighborhood cohort, matched on sociodemographics. Because study participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

    Local Significance:
    There was a lack of significant findings for an intervention effect on HIV-transmission behaviors and mental health. HIV-transmission behaviors were low to begin with and participants had little room for improvement. The populations affected by the HIV epidemic in the U.S. have shifted over the past number of years since a similarly mounted intervention in New York City led to improvements. HIV interventions in the U.S. need to shift their focus to persons living with HIV who are experiencing substantial problems.

    International Significance:
    While the focus of U.S.-based HIV interventions need to shift, interventions for the general HIV population may be effective outside the U.S.

  • Teens and Adults Learning to Communicate (TALC: NYC))

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, Youth and Adolescents, Families, Women
    Geographic Scope National

    Project Name:
    TALC: NYC

    Project Type:
    Living with HIV

    Teens and Adults Learning to Communicate

    Project TALC was funded by the National Institute of Mental Health (NIMH) and is an intervention designed to improve behavior and mental health outcomes among parents with AIDS and their adolescent children. The study sample was comprised of 307 financially-needy, AIDS-infected parents in New York City and 412 adolescent children. The majority (80%) of the parents were mothers. Approximately one-half of the study participants were Latino and over one-third were African American.

    Targeted Risk Group:
    AIDS-infected parents and their children

    Intervention model:
    Cognitive behavioral intervention comprised of two modules. The first module was for parents only (8 sessions) and focused on coping with the HIV illness and disclosure. The second module was for parents and their adolescents (16 sessions) and focused on ways to plan a legacy, e.g. making custody arrangements.

    Research Methods:
    In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Because participants were followed over time, longitudinal random effect regression models were used to test the efficacy of the intervention.

    Local Significance:
    Over the two-year follow-up period, adolescents assigned to take part in the intervention reported significantly and substantially lower levels of emotional distress, conduct problems, and family-related stressors and higher levels of self-esteem than did control group adolescents.

    International Significance:
    Project TALC provided a behavioral intervention that can be adapted for other countries and cultures to improve behavior and mental health outcomes among parents with AIDS and their adolescent children.

  • Together Learning Choices (TLC)

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served Living with HIV, Youth and Adolescents
    Geographic Scope National

    Project Type:

    Living with HIV

    Together Learning Choices (TLC) – formerly “Teens Linked to Care”

    TLC (Together Learning Choices) is an HIV prevention and health promotion intervention developed for HIV-positive teens and youth (ages 13 to 29). TLC is delivered in small groups using cognitive-behavioral strategies to change behavior. It provides young people living with HIV the tools and skills necessary to live their best lives and to be able to make healthy choices. The goal of the intervention is to help these young people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. TLC is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

    TLC consists of two sequential modules that totaled 16 sessions. Each module has eight sessions and is designed to be delivered by two Facilitators in a group setting.

    The Staying Healthy module encourages healthy living by focusing on health maintenance and forging effective partnerships with health care providers.
    The Acting Safe module is dedicated to primary and secondary HIV prevention by addressing sex- and substance use-related risk behaviors and reducing new infections and reinfections.
    – The goal of this study was to design, pilot test, and evaluate an intervention for service providers to address HIV-related stigma and its impact on health service delivery and adequate care.
    TLC is a science-based behavioral intervention that has demonstrated evidence of effectiveness in reducing risky behaviors, such as unprotected sex, or in encouraging safer ones, such as using condoms and other methods of practicing safer sex. It is offered by the Centers for Disease Control and Prevention (CDC) through the Replicating Effective Programs (REP) and Dissemination of Effective Behavioral Interventions (DEBI) at www.effectiveinterventions.org.

    Targeted Risk Group:

    Young People Living with HIV (YPLH) aged 13 to 24 in original efficacy trial and aged 13-29 in . The majority of participants were African-American and Latino.

  • Vaccine Interest and Benefit Evaluation (VIBE)

    At a glance:

    Status Completed
    Principal Investigator Mary Jane Rotheram
    Current Contact Dallas Swendeman
    Population Served HIV Prevention
    Geographic Scope International

    Project Name:
    VIBE (Vaccine Interest and Benefit Evaluation)

    Project Type:
    Vaccine Interest and Benefit Evaluation
    Relatively few studies have addressed consumers’ potential responses after a hypothetical Human Immunodeficiency Virus (HIV) vaccine becomes available for widespread use (e.g., vaccine acceptance, possible changes in risk behavior). Similar consumer research is used widely in the manufacturing industry to inform new product development, marketing and dissemination. We anticipate that the same type of consumer research will be valuable to inform the HIV vaccine research and policy communities to understand the potential demand for vaccines under development, to prioritize research efforts, to design social marketing campaigns for post-trial vaccines, and to design behavioral interventions to accompany vaccination and mitigate potential increases in risk behavior among vaccine recipients.

    This study examines consumers’ demand for HIV vaccines (e.g., would people be willing to be vaccinated?), motivators and barriers to potential trial participation or post-trial adoption, and potential behavioral responses to vaccination, such as increases in risk behavior. We focus on both HIV Vaccine trial participation and hypothetical post-trial HIV vaccines under the “what if” assumption that those vaccines have already been developed and tested favorably, and are ready for dissemination. (No drugs or vaccines are involved in this study; this is not a vaccine trial.) The current phase of the study involves focus groups among communities at risk for HIV in Los Angeles County. Seventeen focus groups have been completed with potential consumers recruited from Sexually Transmitted Disease (STD) clinics, Needle Exchange Programs (NEPs), community based health clinics, and gay and lesbian community centers and include groups of Men who have Sex with Men (MSM), Injection Drug Users (IDUs), African American women, and monolingual Spanish speaking MSM, women, and heterosexually self-identified men. In addition, twelve key informant interviews and one key informant focus group have been conducted with service providers ssociated with these potential consumer groups. The second phase of the study will involve piloting a survey instrument with a sample of a larger number of potential consumers (n=200) recruited and interviewed at the same sites.

    Sample Focus Group Questions:
    If an HIV vaccine were available, what are some concerns your friends might have about being vaccinated (e.g., side effects; testing HIV positive even though they are not HIV infected; it might not prevent HIV infection; that they might be infected with HIV by the vaccine)?

    Would your friends accept an HIV vaccine if it were approved by the US government (Federal Drug Administration – FDA), was 50% effective against HIV infection, and had no side effects? What if it gave you flu-like symptoms for a week?

    Discussion Questions:
    1. How might the availability of an HIV Vaccine influence risk behaviors and prevention messages?

    Current Aspects of HIV Vaccines in Development
    Effectiveness: may only be effective in some persons, against some viral strains, or less than 100% effective in preventing infection.

    2. Will high-risk or HIV positive persons increase risk behaviors if a vaccine becomes available or if a large-scale “Phase 3″ vaccine efficacy trial is implemented in the area?

    3. What kind of prevention messages and activities should accompany HIV vaccine trial participation and post-trial HIV vaccine dissemination?