HIV/AIDS has had a devastating impact on sub-Saharan Africa. With just 8 percent of the world's population, sub-Saharan Africa accounts for 70 percent of all the world's 36.1 million HIV/AIDS cases. Despite the high HIV prevalence rates of as much as 35 percent in neighboring countries, the reported HIV prevalence rate for Angola is reported to be only 3 percent. This relatively low rate may be due to the on-going civil war that has restricted population mobility. Therefore, there is at present a window of opportunity to save Angola from the devastation that AIDS has wrought on other areas of the sub-continent. Our international team of Angolan and American researchers proposes to test the effectiveness of a multi-session HIV/STD prevention intervention on reducing high-risk sexual behaviors and the incidence of sexually transmitted diseases among Angolan military recruits. Our 3 specific aims are: (1) To test the effectiveness of a cognitive-behaviorally focused intervention designed to reduce high-risk sexual behaviors and the incidence of STDs (such as HIV, chlamydia, gonorrhea, and syphilis) immediately following and at 3 and 6 months post-intervention; (2) To determine the degree to which the individual components of the intervention (information about HIV/STDs, motivation to reduce risk of infection, and skills at condom use) produce a reduction in high-risk sexual behaviors and the incidence of STDS; and, (3) To determine if predisposing factors such as sociodemographic and personal characteristics, psychiatric symptoms and disorders, alcohol use and history of STDs moderate the effect of the intervention on sexual risk taking and STD incidence. We will conduct the intervention in the Cabinda Province of Angola. Though Cabinda is the smallest Angolan province, 45 percent of all the country's AIDS cases have been reported there. To better understand the context of HIV prevention for the Angolan military, in Phase 1 we will conduct 5 focus groups with new recruits (2 groups), experienced soldiers, military sergeants, and HIV-positive soldiers. We will use the information gained in the focus groups to modify the content of the instruments to be used in a survey and the proposed intervention. In Phase 2, we will pilot test the survey instrument with 100 soldiers as well as the intervention. The proposed intervention, Salva Vida (Save Life), will consist of 4 sessions (1 session each week) and 1 booster session 6 weeks after the final session. In Phase 3, we will test the intervention with a total of 400 military men, with 200 being assigned to the intervention and 200 to the control condition, which will have a general health promotion focus. If this intervention is effective among military recruits in Angola, it may have applicability to many developing nations throughout the world battling HIV with scarce resources and little hope of treatment.
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