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• Conduct qualitative interviews with our target populations to examine patterns of alcohol consumption and sexual risk-taking, and the relationship between these behaviors and individual, interpersonal and contextual factors.
• Develop and administer a quantitative survey to measure the prevalence and patterns of sexual risk-taking and alcohol consumption, as well as related individual interpersonal and contextual factors in the two target populations.
• Develop, implement and pilot test a risk-reduction intervention to reduce HIV risk-taking in the context of alcohol use among South Indian female sex workers and male migrant workers.
• Develop research capacity in two NGOs serving vulnerable populations in these areas, using a previously successful scale-up model in collaboration with YRGCARE, Chennai.

This study aims to meet the need for in-depth formative research to develop an evidence-based and theorydriven HIV prevention intervention with MSM in Nepal. The study will be conducted in collaboration with the Blue Diamond Society, the only CBO currently serving MSM in Nepal. We will conduct five interviews with key informants who are service providers knowledgeable about HIV risk among MSM to identify sub-populations of MSM, gather initial HIV risk data, assist in the refinement of an interview guide for MSM and assess feasibility of a larger study. Based on this data, we will conduct in-depth interviews with 20 MSM to explore identity, sexual networks, risk perception and stigma. Finally, we will conduct interviews with five key informants who are leaders in HIV prevention among MSM in Nepal and South Asia. These last interviews will help the research team develop relationships with leaders in South Asian MSM HIV prevention and assess feasibility for a larger study. We will engage community members at the beginning and end of this study for their input and engagement as potential community advisory board members in a future study.

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.

This is a three-phase study to identify the specific mechanisms by which MSM stigma affect sexual risk behaviors among MSM in Beijing, China. In Phase 1, we will explore the range of management strategies used to cope with MSM stigma via 30 in-depth qualitative interviews with MSM. In Phase 2, we will develop, using Phase 1 qualitative data and adapting existing quantitative scales, culturally-relevant measures of explanatory constructs of interest (e.g., MSM stigma management) to establish reliability and validity (N=170). In Phase 3, we will examine potential mediators (e.g., stigma management strategies, psychological distress, sexual contexts/situations) that explain how MSM stigma are linked to sexual risk for HIV with a respondent-driven sample of 500 MSM who will complete baseline and two follow-up assessments at 6 and 12 months. We will also conduct 20 in-depth qualitative individual interviews with a subset of men selected from the Phase-3 participants to examine the acceptability of potential intervention components to address the link between MSM stigma and HIV risk.