This proposal is for a competitive supplement to an existing study: a community randomized trial of an HIV prevention intervention in Zimbabwean youth (R01 MH66570-01 PI: COWAN, FRANCES M). The parent study aims to determine the effectiveness of a multi-component program for in and out of school youth delivered in thirty rural communities over 4 years, to prevent HIV, Herpes Simplex virus type 2 and pregnancy. The 30 communities were randomly allocated to early or deferred program implementation in February 2003. Effectiveness will be assessed in a cohort of 6791 young people, who were recruited in 2003 and are being followed until 2007. The trial is going extremely well however the difficult economic and political climate in Zimbabwe has affected the cost of running the study both because the cost of implementation as originally outlined is more expensive than envisaged and because the delivery of the intervention has had to be intensified as a direct result of these factors. A substantial proportion of the target population (25%) has dropped out of school prematurely, largely for economic reasons, increasing the importance of the out of school youth component of the intervention. In addition much more comprehensive community sensitization has been required than originally planned. In addition, data collected in 2003 as part of the baseline survey for the trial suggest that orphans, who make up over 35% of the study population, are at greatly increased risk of HIV infection when compared to young people whose parents are both alive (age adjusted odds ratio 3.43 (95% Cl: 1.93-6.11). In fact the majority of HIV infected young people within our study cohort are orphans (33/51 65%). Thus, this proposal is also for funding to expand the investigation of the causes of vulnerability among this group to HIV within our existing study population. An additional, but highly related objective is also included. Competitive supplement objectives: ? i)To complete the parent study as originally outlined but expanding secondary objectives in order to: ? a) Explore in detail, through a variety of participatory and qualitative methods, the causes of vulnerability to HIV among young Zimbabweans living in rural areas, especially out of school youth and orphans. This will include a detailed assessment of poverty, psychological morbidity, stigma, and empowerment and their impact on behavior and HIV risk. b) Conduct an experimental comparison of four different questionnaire delivery methods to determine the most valid means of collecting socially censured information from young people in rural Zimbabwe. The most valid method will then be used in the final outcomes survey for the parent trial. ? ? ?
