This collaboration between the University of California, San Francisco and Cayetano Heredia University in Lima, Peru brings together a unique group of scientists with experience in the development and evaluation of diffusion and community intervention models, a line of research addressing sexual health among youth in Peru and other countries of Latin America, experience developing and fielding international multi-site randomized controlled HIV preventive interventions, and extensive U.S. studies of Hispanic men who have sex with men. The proposed community HIV-preventive intervention trial addressing young people in four cities of Peru includes: (1) an ethnographic study involving mapping, structured observation, key informant interviews, and focus groups with young people, to be conducted during year 1, in order to identify potential public opinion leaders, appropriate risk behaviors to address, and adequate norm change messages, as well as ground the intervention in the local cultural contexts; (2) a pilot study of the intervention and study procedures, to be conducted in a city not included in the main trial in the beginning of year 2; (3) the intervention trial, to be conducted with pre- and post-intervention cross- sectional surveys and two data collection waves of a nested cohort study being conducted in each city during years 2 and 4, and with the intervention being implemented in two of the four cities during year 3, while the other two remain as waiting-list control communities and receive the intervention during year 5; and (4) data analysis, to be conducted - and publications to be prepared - during year 5. Cross-sectional studies in the trial will address self-reported behavioral and contextual variables, while the nested cohort study will gather biological data. We propose to study young men and women in the 20-24 age group, since this is a particularly sexually active group where rates of marriage are still low, and where casual sexual activity is high. The four sites will be the cities of Iquitos, Pucallpa, Chiclayo, and Trujillo. We propose to focus our work on the most meaningful venue in the Latin American context, namely barrios (neighborhoods) in the cities of interest. Barrios in Peruvian cities are well-organized residence areas that include a substantial proportion of the city population. The intervention as designed now will contain the following elements: Motivating and involving community stakeholders, selecting a Youth Advisory Board, selecting community public opinion leaders (C-POLs), recruiting and training potential C-POLs, developing program messages, establishing a reference directory of health resources available for issues related to sexual health, implementing the sexual health campaign, consideration of other program elements. The program will be applicable to many similar settings in Latin America.
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