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This study is a collaboration between UCSF, UC Davis, the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore and the TATA Institute of Social Sciences (TISS), Mumbai. The field sites are located in Bangalore and Mumbai, two large Indian cities situated in high HIV prevalence states. The study is designed to:

• Examine the nature, extent, and context of AIDS stigma and discrimination by gender, at multiple levels, among people coming into contact with urban health care systems, including: people living with HIV/AIDS, healthcare staff and the general population of patients seeking healthcare in outpatient settings.
• Measure the health-relevant consequences of AIDS stigma and discrimination among both perpetrators and targets of stigma. These include the influence of stigma on HIV testing, on disclosure, on treatment seeking, and on willingness to provide care and treatment.
• Develop a culturally-specific theoretical understanding of AIDS stigma and health in urban India as well as measures of AIDS stigma that can be used to evaluate future stigma reduction policies and programs in healthcare and community settings among victims and perpetrators.
• Develop empirically-based programs and policy recommendations to reduce AIDS-related stigma and discrimination in urban Indian healthcare settings and to disseminate these.

The overall goal of this study is to enhance the physical and mental health of rural Indian women living with AIDS and their children. We will achieve these goals through the use of trained village women as Accredited Social Health Activists (ASHA) to enhance the health of women and children through improved ART adherence, CD4 levels, and physical and mental health. This Indo-US collaboration between University of California, Los Angeles, University of California, San Francisco and All India Institutes of Medical Sciences (AIIMS) builds on our previous work with rural women living with AIDS and our successful ASHA program. Specific objectives include:

• Using a 2x2 factorial design, we plan to assess the effects of nutrition training and/or food supplements on primary outcomes for rural women living with AIDS in improving body composition and immune status (CD4 levels) as assessed at 6-, 12- and 18-month follow-up.
• Examining the effects of the program arms and their interaction on adherence to ART, psychological health, nutritional adequacy, and lipid profile over time.

This study brings together researchers from the University of California, San Francisco; Research Triangle Institute in Washington DC; St. John’s National Academy of Health Sciences in Bangalore, India; and the All India Institute of Medical Sciences in New Delhi, India to evaluate the efficacy of a promising intervention designed to reduce HIV stigma among Indian health professionals. The intervention builds on results of our previous research, identifying prevalence and drivers of stigma and discrimination in Indian healthcare settings among PLHIV, health care providers and uninfected patients. Specifically, the study will:

1. Adapt our pilot-tested 3-session stigma reduction intervention for partial tablet-based delivery to increase its long-term sustainability in health care settings. The two tablet-administered sessions of the intervention use interactive touch screen methodology and video vignettes tailored to situations likely to be encountered by Indian nurses and ward attendants. The third session focuses on skills-building in a group format and is co-facilitated by a PLHIV.
2. Evaluate the efficacy of the intervention in 24 hospitals in North and South India on:
   1. behavioral manifestations of HIV stigma, including endorsement of coercive policies, behavioral intentions to discriminate, and non/stigmatizing provider-patient interactions.
   2. the factors underlying stigma proposed by our conceptual model and targeted in the intervention modules, including fears and misconceptions regarding casual transmission (instrumental stigma), and negative attitudes toward marginalized, vulnerable groups (symbolic stigma).

The overall goal of this study is to improve screening, diagnoses and treatment of Common Mental Disorders among individuals with dual mental illness and cardiovascular disease diagnoses in rural South India. The multi-level intervention uses a collaborative care model that will be tested in a cluster RCT and includes low-cost, evidence-based sustainable strategies targeting multiple chronic diseases. This five-year study is being conducted in collaboration with our colleagues at St. John’s National Academy of Health Sciences in Bangalore and the Karnataka State government. Specific objectives include:

• Train community health outreach workers (ASHAs) to conduct community-based screening of depression, anxiety, type-2 diabetes and CVD risk factors during community health fairs to examine: a) whether this increases subsequent diagnoses in the Primary Health Clinics (PHC) of patients diagnosed with co-morbid mental health and chronic disease; and b) whether such patients are as likely to remain in treatment, compared to the standard PHC-based screening.
• Implement and evaluate the effects of providing staff training in the collaborative care model of integrated mental health (depression, anxiety) and cardiovascular disease (hypertension, diabetes, CVD) to PHC staff and compare them to control PHC staff with respect to: a) knowledge and clinical skills using clinical patient vignettes; and b) perceived satisfaction reported by clinic patients in intervention and control PHCs.
• Evaluate the effects of our multi-level integrated clinic and community-based intervention for co-morbid primary care patients compared to the enhanced standard non-integrated treatment services in a cRCT with 50 participating PHC, with regard to both mental and physical health outcomes at post-intervention, 6 and 12 month follow up.

This multidisciplinary study includes epidemiological research on prevalence and incidence of HIV, chlamydia, gonorrhea, and human papillomavirus (HPV), as well as rates of drug use including amphetamine-type stimulants (ATS) among young women in Phnom Penh, Cambodia working in the sex and entertainment service sectors and who have multiple sexual partners. Medical anthropology and psychological experts will assess cultural mediators of risk and preventive behaviors, including uptake of HPV vaccine. This is the second wave of this prospective study. YWHS is a collaboration between CWDA, a small, women-run NGO, and the NCHADS. Using a community participatory approach, CWDA will conduct qualitative research recruitment of study participants, and ensure that retention of study participants is maintained at high rates through follow up within established communitybased networks in Phnom Penh. NCHADS clinical staff including health care and HIV counseling staff will assess biological outcomes, risk and provide ongoing HIV prevention and treatment access. The study will:

• Enroll 300 women aged 15-29 who report more than two sexual partners within the past month or engaging in transactional sex within the past three months.
• Screen the women for HIV, STD and HPV infections.
• Administer a behavioral interview on demographics, sexual risk and drug-use behaviors.
• Assess ATS use using urine screening.
• Conduct HPV testing and gynecological assessments to assess HPV infection, cytology and cervical disease. All consenting participants will be followed prospectively for up to two years with quarterly follow-up visits. Recruitment and follow-up strategies will be monitored in preparation for future larger prevention research studies including HIV vaccine, microbicide, and chemoprophylaxis trials.