HIV infection is rapidly moving from urban areas to smaller towns and rural areas where the epidemic can quickly have devastating effects on the viability of small local populations. At particularly high risk are Native Americans and other minority groups whose HIV-risking substance abuse and sexual norms and culturally shaped health belief systems have left them relatively inaccessible to both AIDS prevention broadcast media and urban styles of street outreach preventive interventions. Our proposed project addresses several rural high risk cultural groups that have been neglected by HIV outreach prevention research. Its overall purpose is the development, implementation and evaluation of an innovative method of culturally shaped outreach intervention which as compared to conventional outreach would be demonstrably superior in reducing HIV- risking behaviors while increasing preventive intentions. The project's four ethnic target groups are Navajo and Hopi Native Americans, Hispanics and Anglos. The targeted subjects for intervention are IVDU's, non-IV substance abusers, their sexual partners, and other individuals whose lifestyles place them at higher risk for HIV infection. The project would be conducted by an interdisciplinary collaborative team of investigators and consultants experienced in ethnography. HIV/AIDS prevention and epidemiologic research, and evaluation of community based intervention studies. Project Phase 1 involves preparatory mapping of risk environments and ethnographic investigations to define effective, culturally appropriate elements of the experimental outreach interventions plus the monitoring/surveillance strategies. Phase 2 (beginning 01 year 4th quarter) implements a quasi-experimental study testing the relative effectiveness of the intervention strategies. Using pre and post- intervention plus follow-up assessments of process and outcome variables. Both outreach interventions include the use of natural discourse and culturally appropriate metaphors, but one is conventionally didactic in its risk-reduction information transmission while the other uses an enhanced story-based approach which is traditionally used by many rural minorities and in Native American cultures in particular.
