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Transgender women (people who were assigned ‘male’ at birth but identify as female) are disproportionately impacted by HIV, especially transgender women of color. The specific aims of this research are:

• Conduct 15 qualitative interviews to describe the influence of transgender women’s unique 1. cultural context on their HIV-related risk and behaviors and protective factors.
• Create new and adapt existing quantitative measures to more accurately assess psychosocial 2. dimensions and behavior relevant to transgender women’s HIV risk and protective factors based on the qualitative data collected for Specific Aim 1
• Survey 150 transgender women to identify psychosocial influences on HIV-related sexual and 3. injection risk behaviors and protective factors, using the new and adapted quantitative measures created in Specific Aim 2
• Develop and test the feasibility and acceptability of a theory-driven, culturally grounded HIV 4. prevention intervention for transgender women, based on the qualitative and quantitative data collected in Specific Aims 1 and 3

This project characterizes the STI testing and treatment environment for young, African American men in San Francisco, CA, by exploring STI services use, barriers to care, and preferences for future diagnostic technologies and testing strategies. This cross sectional study is conducted among 100 men aged 15-24 using a street intercept survey in predominantly minority, low income neighborhoods in San Francisco. Recruitment for the study is conducted as part of outreach efforts undertaken by the city’s STD branch at the department of public health. Participation includes completion of a structured, self-administered survey using a web-based interviewing tool. By eliciting questions regarding STI services use, STI-related knowledge, perception of gender norms and social stigma related to STI, and acceptability of varied diagnostic methods and test settings, we hope to generate data to better understand the testing and treatment environment for young African American men. The data generated will inform a future intervention proposal that aims to increase is the reach of effective STI prevention strategies, given the disproportionate burden of STI/HIV that young African Americans bear.

Building on the results of three efficacious HIV prevention programs with those at high HIV risk (LIGHT, Adolescent LIGHT, & Street Smart), this study aims to examine the relative efficacy of LIGHT in an interpersonal or a computerized delivery format, in contrast to a standard care HIV prevention condition. The project has proceeded in two phases. During Phase 1, we further enhanced the existing computerized LIGHT prevention program to ensure acceptability; finalized and programmed assessment measures on a combination ACASI/CAPI program; finalized recruitment scripts and tracking programs; and conducted orientation sessions for all school personnel, parents, and stakeholders. The main intervention trial, Phase 2, utilizes a complete randomized block design with youth recruited over a two-year period. Twenty four schools (n=960 students) in the Los Angeles Department of Education were randomly assigned into one of three experimental conditions: Interpersonal Light in 8 schools 1. Computerized Light in 8 schools (n=320 youth) 2. A standard HIV control condition 3. Youth in each condition are assessed at a baseline interview, and reassessed longitudinally at three, six and 12 months.

Street Smart (SS) is an effective HIV preventive intervention for homeless youth selected by the CDC as part of Replicating Effective Programs. However, substantial relapse diminishes the program’s effects over two years. This study examines a computerized strategy for maintaining the efficacy of the SS intervention for 400 homeless youth in Los Angles, CA. A two-stage sampling strategy (agency level and then youth within agency) was conducted in a randomized controlled trial examining the efficacy and cost-effectiveness of SS for reducing risk for HIV among homeless youth aged 12-20 years in three conditions:

• SS, but no maintenance strategy
• SS and a 2. computerized internet-based strategy for behavioral maintenance (Computerized SS; n=100)
• A one-session AIDS video Control Condition (CC; n=100)

Based on a social learning theory, the maintenance strategy provides skill training, social support, informational updates, and access to an expert for consultation, referrals, and coping with emerging crises. Youth are assessed at recruitment, and at three-, six-, 12-, 18-, & 24 month intervals in three domains:

• Youth’s substance use and sexual behaviors.
• Youth’s and staff members perceptions of the program’s acceptability and quality and program. utilization over time.
• Generalization of the program’s effects on youth’s problem behaviors (sex work, delinquent acts,. conduct problems, school truancy/unemployment, emotional distress, and chronic homelessness).

Three recent independent national datasets suggest that the rate of new HIV infections in Botswana appears to be declining, as evidenced by decreased prevalence among pregnant women aged 15-49. However, it is still uncertain why these declines have been observed and the extent to which behavioral changes (e.g., monogamy, condom use) have been causally associated with the decline. The goal of this study is to use qualitative research methods to lend additional depth to existing surveillance data that suggest that HIV prevalence among young people in Botswana is declining. Focus group discussions and individual in-depth interviews are conducted with Local. youth service providers Youth between the ages of 18-24. Adult key informants in three districts selected for regional diversity and variation of trends in HIV. prevalence By gathering information from young people and key informants who provide health-related services to young Batswana, we will gain valuable insight into the behavioral and contextual factors that may assist in explaining the observed decreases in HIV prevalence. Qualitative methods will allow us to explore the meanings and variations of the sexual experiences of young Batswana. This work may also lead to the development of innovative behavior change strategies to help support the decreased spread of HIV in Botswana.