Library

In 2012, there were 2.3 million new HIV infections globally. A large proportion of people newly diagnosed with HIV worldwide are in their reproductive years and these men and women are likely to want children in the future. Addressing the sexual and reproductive health and rights of this population is critical to addressing the spread of HIV because HIV infection in childbearing women is the main cause of HIV infection in children. Treatment for those who are already infected is also central to stopping the spread of HIV to infants and to uninfected sexual partners.

The principal objective of the International Core at the Center for AIDS Prevention Studies (CAPS) is to facilitate high quality international research by creating effective and productive partnerships between CAPS scientists and HIV prevention researchers from developing countries. The International Core brings together CAPS scientists and alumni of the Collaborative Prevention Research in Developing Countries Program, a training program for new developing country researchers (described below). CAPS has successfully developed a broad portfolio of small-scale international research projects conducted by CAPS scientists and Program alumni. Together we have made important contributions toward understanding how to prevent HIV transmission and how to care for the HIV-infected in the developing world.

The TETAC provides the HRSA Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color initiative with expert leadership in the multi-site evaluation and dissemination of findings and technical assistance (TA) and capacity building to improve the timely entry, engagement, and retention in HIV primary care for transwomen of color. The project is guided by four primary goals:

• Goal 1 (Evaluation) To provide support to the demonstration sites as they design and implement their site-specific evaluation plans, and to conduct rigorous, cross-site evaluation research that will make a significant contribution to improving the timely entry, engagement, and retention (from the cascade of care model) in quality HIV primary care for transwomen of color.
• Goal 2 (TA) To provide TA tailored to the specific needs of each demonstration site through teleconferences, a website, webinars, site visits, and meetings in a variety of domains including (1) program development, implementation, and sustainability; (2) clinical consultation; (3) multi-site and location evaluation; (4) human research protection; (5) IRBs; and (6) intervention manuals.
• Goal 3 (Capacity Building) To provide capacity building assistance (CBA) relating to the provision of quality clinical and culturally competent HIV primary care and social services to transwomen of color.
• Goal 4 (Dissemination) To synthesize and disseminate findings from demonstration projects to optimize impact on the timely entry, engagement, and retention in quality HIV primary care for transwomen of color.

Facilitated by The Twinning Center, the UCSF School of Nursing has partnered with the Ministry of Health in Mozambique in order to adapt, pilot, and implement an US evidence-based Positive Prevention (PP) intervention within rural Mozambique. The purpose of this project is to develop a PP intervention that will effectively address the needs of people living with HIV (PLHIV) in Mozambique through advancing understanding among healthcare providers, counseling and testing staff, and peer educators. Beginning in 2006, this intervention is taking place in two sites in Maputo Province in Mozambique. The first site focuses on building healthcare provider skills around effective risk assessment and prevention messages for their HIV-infected patients. The second site focuses on implementing similar needs assessment and prevention messages within one community–based Voluntary counseling and testing center and an accompanying peer support group. Collaboration among US and Mozambican partners (including healthcare providers, counseling and testing counselors, and PLHIV peer counselors) has guided the development of this PP intervention. The intervention currently includes case studies developed by Mozambican partners and a peer-led support group with enhanced one-to-one risk reduction counseling by counselors and PLHIV peers. Case studies are used in each setting to illustrate concepts such as assessment of transmission risk, behavioral risk reduction approaches, encouragement of partner testing and disclosure, prevention of mother-to-child transmission, and family planning.

In China, sexual transmission has become the major driving force behind the HIV epidemic, accounting for more than half (52%) of the estimated 700,000 people currently living with HIV. Men who have sex with men (MSM) may contribute to the rapid acceleration of the epidemic throughout China. Studies with Chinese MSM have documented an increasing HIV prevalence, a high HIV incidence, and high rates of unprotected intercourse and sexually transmitted infections (e.g., syphilis) known to facilitate sexual transmission of HIV. Moreover, our work found that HIV-transmission risk behavior is highly prevalent among HIV-positive MSM in China. Nonetheless, no HIV prevention interventions have targeted HIV-positive Chinese MSM. Several interventions have demonstrated efficacy in reducing sexual risk behaviors among HIV-positive MSM in the U.S. Adapting such interventions for HIV-positive MSM in China would help accelerate the process of developing an efficacious intervention for this risk group. The proposed three-year study (R34) will adapt and pilot-test currently available evidence-based behavioral interventions to reduce HIV-transmission risk behavior among HIV-positive MSM in Chongqing, China. This study will be implemented in five phases, guided by Wainberg et al.’s intervention adaptation model. In Step 1, we will identify core components of efficacious interventions (e.g., key theoretical constructs, intervention messages, delivery modes) through the review of the literature. In Step 2, we will explore cultural, psychosocial, and contextual factors associated with sexual risk behaviors and generate ideas for intervention strategies for HIV-positive MSM by conducting 15 key informant interviews with individuals knowledgeable about HIV-positive MSM and 30 in-depth interviews with HIV positive MSM. In Step 3, we will adapt efficacious interventions through reviewing the core elements of efficacious interventions identified in Step 1 and collating those elements with qualitative data collected in Step 2 with an intervention adaptation working group of 10 health professionals and MSM lay workers who serve HIV-positive MSM. In Step 4, we will pilot-test the adapted intervention with 16 HIV-positive MSM and refine the intervention if necessary. In Step 5, we will test the feasibility of implementing and assessing the intervention refined in Step 4 by conducting the intervention with 50 HIV-positive MSM and having these 50 men complete baseline and 3-month surveys.