This R34 application is seeks 3 years of support to develop and conduct a preliminary pilot test of an HIV/STI risk-reduction intervention for university students in South Africa. This research has great public health relevance because Sub-Saharan African countries, including South Africa, have a generalized HIV epidemic and the highest rates of HIV/AIDS in the world. The primary mode of infection in South Africa, as in most Sub-Saharan African countries, is heterosexual contact. In a generalized HIV epidemic, curbing sexual transmission of HIV requires behavioral interventions to reach all populations that engage in risk behavior. Few studies have tested HIV sexual risk-reduction interventions specific to university students in Sub-Saharan African countries with a generalized epidemic. Accordingly, the broad, long-term objective of the proposed research is to identify interventions to dissuade university students in Sub-Saharan Africa from engaging in HIV sexual risk behaviors.
The Specific Aims are to;(a) develop a theory-based, contextually relevant HIV sexual risk-reduction intervention, (b) conduct a pilot test of its efficacy as compared with a health-promotion control intervention on health issues unrelated to sexual behavior, (c) explore whether participants'gender or nationality moderates its efficacy, and (d) determine the mediators of its efficacy. The approach draws on social cognitive theory, the theory of reasoned action, the theory of planned behavior, and formative research with the study population. The primary outcome is frequency of unprotected intercourse in the previous 3 months collected preintervention and at 6- and 12- month follow-up via audio-computer-assisted self-interviewing (ACASI). Secondary outcomes include incidence of abstinence, multiple sexual partners, and consistent condom use and theoretical mediator variables, including intentions, beliefs, and self-efficacy. This exploratory research will yield valuable preliminary data to support a subsequent R01 to implement a full-scale clustered randomized control trial to test the efficacy of a HIV sexual risk-reduction intervention for university students in a region of the world where a generalized HIV epidemic is taking a most devastating human toll.
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