HIV prevention outcome trials are designed primarily to test the efficacy of an intervention but frequently leave unanswered many important theoretical and practical questions about the processes through which the intervention produces behavior change effects, the mechanisms by which the intervention works, for whom it works best, and how risk reduction behavior changes were made and how they positively or negatively influence participants' relationships. An NIMH-supported randomized trial, now underway in Eastern Europe, is evaluating the outcomes of an HIV prevention intervention that recruits high-risk social networks in community venues, and identifies and trains the leader of each social network to counsel other network members in risk reduction. Preliminary analyses already show that the intervention is producing large sexual risk reduction effects. The research proposed in this application consists of one quantitative and two qualitative studies that will explore the model's mechanisms and underpinnings with a sample of 68 networks that are participating in the intervention trial in St. Petersburg, Russia. The quantitative study will collect additional data to analyze how intervention effects may depend upon social network density, temporal stability, strength of leader social status, and frequency of member interaction. After the parent study's final follow-up, two new qualitative studies will be conducted. One will consist of focus groups that include all members of 24 intact social networks, half who received the network intervention and half from the present study's control arm. The focus groups will represent those networks that most reduced their HIV risk behavior and those that least changed in their risk behavior levels. The other qualitative study will consist of individual in-depth interviews with the 40 participants who most-and the 40 who least-reduced their own risk behavior. Focus groups will examine processes and communication patterns that took place in formerly high-risk networks following intervention. In-depth interviews will explore how participants made risk reduction changes, the impact of changes in their relationships, and factors that facilitated or impeded their risk reduction behavior change efforts. There is growing interest in the field for testing network-level HIV prevention interventions. The proposed research will enhance our theoretical understanding of the risk reduction behavior change processes that occur in social networks. The work carries applied public health significance because its findings can guide service provider programs based on social network intervention approaches. Although this research will involve analyses related to a social network intervention being carried out in Russia, findings of the study are expected to also more generally shed light on theoretical and applied issues relevant to social network HIV prevention approaches carried out in the U.S.
