This is a revision of an application (1 RO1 MH073361-01) reviewed in March 2004.The HIV/AIDS pandemic is having a devastating impact on the Nigerian Armed Forces. A recent United States Intelligence Council Report estimated an HIV/AIDS prevalence rate of 10-20% among the armed forces of Nigeria. As the largest and one of the most significant countries in the African continent, Nigerian security forces play a major role as peacekeepers both within the region and for the United Nations. The United Nations has noted that peacekeepers are magnets for sex workers and that peacekeepers not only bring new strains of HIV home but also introduce them to the countries where they are deployed. To date, only a limited number of studies have tested the efficacy of theory based HIV prevention interventions among the armed forces of Nigeria. Although HIV/AIDS intervention programs that are derived from social cognitive theory and based on cognitive-behavioral principles have demonstrated promise in changing HIV high-risk behaviors, most of the cognitive behavioral interventions tested to date have relied on professional interventionists with expertise in cognitive behavioral skills techniques, making them difficult to transfer to resource poor countries and geographically mobile groups such as Nigerian peacekeepers. This application requests three years of support of research to adapt, implement, and evaluate the efficacy of an HIV-risk reduction skills training intervention conducted with videotapes and facilitated by enlisted men with minimal training in counseling and facilitator skills techniques in an effort to increase the generalizability of video-based skills training as a feasible and cost effective method of HIV prevention in a military establishment. Four hundred enlisted men (N=200) and women (N=200) who meet high-risk behavior criteria will be assigned to one of two experimental conditions: (1) A comprehensive HIV-risk reduction intervention based on cognitive behavioral principles delivered by videotape and facilitated by enlisted men with minimal training in counseling and facilitator skills techniques; or (2) A time- and contact- matched standard HIV education only control condition. The study will therefore use 2 (intervention) conditions X 2 gender factor designs to test the following hypotheses: (1) The HIV prevention intervention is expected to result in increased HIV-related knowledge, sensitization to HIV-risk, and intentions to change risk behaviors relative to the control group; (2) The HIV prevention intervention is expected to result in increased self-efficacy for reducing behaviors and increased effectiveness in communicating ways to reduce risk with sexual partners; (3) Participants in the HIV prevention intervention are expected to experience significantly greater reductions and longer-lasting maintenance of behavioral change in unprotected sexual intercourse, decreased numbers of sexual partners, and increased use of condoms relative to the control group. If the delivery of skills instruction via videotape and military facilitators proves successful, we would have established the generalizability of videotape-based HIV prevention intervention as a feasible and cost effective method of HIV prevention among enlisted men and women in the Nigerian army. The intervention may also have applicability to military establishments in other resource poor countries with a high prevalence of HIV/AIDS.
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