The recognition of AIDS as a global problem, rather than one limited to national boundaries, has required substantial changes in our understanding of the interplay between culture and human behavior and of the influences thereon. The importance of behavior in the acquisition, transmission, treatment, and prevention of HIV/AIDS has resulted in the active incorporation of models of behavior and behavioral change in virtually all successful prevention and treatment approaches. However, most effective behavioral intervention programs are based on Western-derived theories of behavior change (notably, social cognitive theory) that involve concepts of individual determinants of behavior. By contrast, in many of the countries (including China) now experiencing the HIV epidemic, the prevailing culture subscribes to the perspective of collective values, shared tradition, and communal decision-making rather than the individualistic perspective common in the United States and other Western countries. Therefore, an important research question will be whether a Western theory-based behavioral intervention program, through appropriate adaptation and modification, can be effective in a different cultural setting. In this application, we propose a community-based randomized controlled trial among 1,300 young rural-to-urban migrants (18 to 24 years of age), a population at risk of HIV/STD infection, in China to test the efficacy of cultural adaptation of a social cognitive theory-based behavioral intervention program in reducing sexual risk among young people in a different cultural setting. We also propose to examine whether the effectiveness of an intervention will be moderated by cultural orientation (e.g., individualism versus communalism) of a growing population of young migrants in China and whether the constructs of the Western-developed model of behavioral change predict changes in behavioral outcomes and biomarkers. The proposed intervention program is a multiple session behavioral intervention that will be delivered through small groups in a structured setting. The primary behavioral outcomes will be the consistent use of condoms. Incidence rates of three common STDs will be employed as biomarkers in the evaluation of intervention effect.
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