This is a proposal to develop and implement a community-based risk reduction intervention among Puerto Rican women living in Cuyahoga County, Ohio and Mexican women living in San Diego County, California. Phase 1 will include developmental activities including recruitment and conduct of focus groups in both sites and development of the study instruments. Phase 2 will be descriptive: tasks include 150 interviews in each site and development of the intervention protocol. Phase 3 is the intervention trial, designed to utilize indigenous health educators to increase levels of knowledge about HIV infection risk, decrease sexual risk taking behaviors, increase sexual protective behaviors, and increase individuals's presentation for HIV testing. The study design will be based on social cognitive theory, as well as the theory of gender and power, and will be developed within a culturally- sensitive framework. The intervention conditions will include a comparison condition of a single intervention visit to a women participant by an indigenous health educator, and two intervention alternatives: a single visit to the participant and her primary partner, and a series of four weekly visits to the couple. The hypothesis is that the extended intervention will increase abstinence or condom use, reduce the number of sexual partners, and increase seeking HIV testing.
