This research proposal is in response to the request for Applications 'Integrative Prevention Research for Alcohol Users At-Risk for HIV/AIDS' (RFA-AA-07-020) and requests 4 years of support to conduct developmental research to design and field test a culturally adapted theory-based behavioral risk reduction intervention for men and women who use alcohol and are at risk for HIV infection in the city of St Petersburg in Russia. Russia has one of the highest HIV incidence rates in the world and HIV prevalence in St Petersburg increased 100-fold (from 0.013% to 1.3%) between 1998 and 2003, mostly affecting young injection drug-users. While HIV prevalence in the general population in Russia has remained low, a young sexually active population with high risk sexual behavior, high levels of alcohol abuse, and low levels of knowledge of HIV transmission provides fertile ground for an expanding HIV epidemic that becomes generalized in the heterosexual population. Guided by a previously tested Information-Motivation-Behavioral Skills model of health promoting behaviors we will conduct 3 phases of intervention development research: (1) Initial interviews, focus groups, and quantitative surveys with men and women who use alcohol and are at risk for sexual HIV transmission in the city of St Petersburg in Russia. Based on information gained from these rapid formative studies, this first phase of research will design a theory-based alcohol related risk reduction intervention; (2) Test the feasibility of the culturally-adapted alcohol related HIV risk reduction intervention with a small sample of men and women who use alcohol and engage in sexual risk behavior, and (3) Conduct a randomized field test to determine the potential efficacy of the alcohol risk reduction intervention for men and women in St Petersburg, Russia. Participants in the field test will be randomly assigned to either receive the newly developed intervention or assigned to a time- matched attention comparison condition. Following a 6-month follow-up period, we will test for differences between groups on sexual behavioral outcomes. We will also test the mediating effects of information, motivation, and behavioral skills constructs on intervention outcomes. Results of the proposed research will provide critical information about the role of alcohol in HIV transmission risks and will offer urgently needed strategies for improving HIV prevention interventions in St Petersburg, Russia. ? ? There are estimated 300,000 HIV infections in Russia and with the increasing number of HIV infections transmitted sexually, intervention initiatives in Russia need to target women and youth as the agent of behavior change. Russian investigators concerned with the HIV epidemic believe that it is imperative for behavioral research to rapidly develop and test interventions targeted to men and women at risk for HIV. We propose to immediately develop and test a theory-based risk reduction intervention for men and women who drink alcohol, who are seeking VCT at STI clinics and are at risk for contracting and transmitting HIV in St Petersburg, Russia. ? ? ? ? ? ? ?
