This revised proposal requests 4 years of support to conduct developmental research to design and field-test a gender and theory-based behavioral risk reduction intervention for men who are at risk for perpetrating violence against women and at risk for contracting and transmitting HIV in Cape Town, South Africa. As many as one in five South Africans is HIV positive and there are an estimated 1,600 new HIV infections in South Africa each day. South Africa also has the world's highest rates of violence against women and sexual coercion is associated with women's increased risks for HIV infection. Guided by the social constructionist theory of gender and the Information-Motivation-Behavioral Skills model of health promoting behaviors we will conduct 3 stages of intervention development research: (Stage 1) initial interviews, focus groups, and quantitative surveys with men and women in a community center in a Cape Town township. Based on information gained from rapid formative studies, this first phase of research will develop a theory-based gender-based violence and HIV-related risk reduction intervention; (Stage 2) Test the feasibility of the newly developed intervention with a small sample of men and receive feedback on the intervention content from women in the community. Stage 2 will also test the feasibility of an audio-computer assisted interview for data collection in the community center; and (Stage 3) Conduct a randomized field test to determine the potential efficacy of the risk reduction intervention for South African men at risk for gender-based violence and HIV. Participants in the field test will be randomly assigned to either receive the newly developed intervention or a time matched attention comparison condition. Following a 6-month follow-up period, we will assess differences between groups on behavioral outcomes. We will also test the moderating effects of gender-based attitudes and beliefs on HIV risk reduction constructs and intervention outcomes. Results of the proposed research will also provide critical information about the role of gender power differentials, attitudes toward women, and AIDS stigmas in HIV transmission risks in South Africa and will offer urgently needed strategies for improving HIV prevention interventions in South Africa. ? ?
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