The objective of this supplement is to conduct a randomized controlled trial to test the efficacy of a culturally and gender appropriate HIV prevention intervention in reducing the risk of sexually transmitted infections (STIs) among 560 Xhosa women in the Western Cape of South Africa. The study will recruit Xhosa women between the ages of 18-29, who screen HIV negative after seeking voluntary counseling and testing (VCT), at one of 4 rural study clinics in the Western Cape. The participants will be randomized to one of two study conditions: a 4-session HIV prevention intervention (experimental condition) or a 4-session general health promotion intervention (comparison condition). This project is a collaborative effort between Drs. Wingood, DiClemente, and Holtgrave (Emory CFAR Behavioral Core), Dr. Caliendo (Emory CFAR Virology Core), and Dr. del Rio (Emory CFAR Clinical Core). We will also collaborate with Dr. Reddy, Director of the National Health Promotion Research and Development Office at the Medical Research Council (MRC) in Cape Town, South Africa; Dr. Tony Mbweku, Director of Research at MRC; Dr. Grimwood, Senior Scientist, South African Vaccine Initiative; Dr. Unwaar Hoosen, Department Head, Department of Medical Microbiology, Medical University of Southern Africa (MEDUNSA) and the Clinical Directors of the rural clinics. There are 6 aims: ? 1. To evaluate whether women in the HIV intervention condition have a lower incidence of STIs over a 12-month follow-up period relative to women in the comparison. ? 2. To evaluate whether women in the HIV intervention condition show a greater increase in condom protected sexual intercourse over a 12-month follow-up period relative to women in the comparison. ? 3. To evaluate whether the HIV intervention condition is cost-effective in averting STIs over a 12-month follow-up period relative to women in the comparison. ? 4. To evaluate whether women in the HIV intervention condition demonstrate a greater increase in mediators associated with HIV sexual risk-reduction such as: HIV knowledge, attitudes towards condom use, outcome expectancies, sexual communication and peer norms relative to women in the comparison. ? 5. To evaluate whether variables such as alcohol use, trauma from apartheid, and loss of kin from HIV moderates the efficacy of the HIV intervention condition. ? 6. To determine HIV incidence at the 12-month follow-up assessment among all study participants. ? ?
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