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This project is an extension of the International Traineeships in AIDS Prevention Studies Program (I-TAPS) through a partnership with the Centro de Estudos de AIDS do Rio Grande do Sul (CEARGS) in Porto Alegre, Brazil and with the Universidade Federale do Bahia (UFBA) in Salvador, and funded by the Fogarty International Center. It is aimed at training Brazilian scientists, as well as scientists from other lusophone countries, in AIDS prevention research, with a focus on epidemiological and behavioral studies. In-country training at CEARGS and UFBA are conducted in Portuguese. Our Brazilian collaborators work in conjunction with the Brazilian Ministry of Health, UNAIDS, CDC, and other partners to identify trainees from all across Brazil. The main goal is to provide self-sufficiency for research scientists, capable of designing and implementing AIDS prevention research, independently or in collaboration with US investigators. This project began in 2001 and was renewed for 2006-2011. In the first funding cycle, training of Brazilian scientists was supported both at CAPS and in Brazil. In the current funding cycle, we continue to recruit and support Brazilian scientists at CAPS, but supported through other sources. We also have had two Brazilian scientists join us at CAPS as advanced research trainees, preparing grant applications to the NIH on which the trainee is the principal investigator. Our primary focus of our ICOHRTA funding is on in-country training, and an expansion of this training to reach scientists in previously underserved parts of the country. At CEARGS in Porto Alegre in the south of Brazil, 168 Brazilian scientists have been trained since 2002 in several short courses on clinical research methods, basic epidemiology, data management and analysis, and scientific writing. A distance learning component was added at the end of 2005, enabling scientists from all over Brazil to attend the basic clinical research methods trainings through teleconferencing, and a distance learning scientific writing module is also under development. In the current funding cycle, a second training site, in addition to CEARGS, has been established at UFBA, in order to attract scientists from the north and northeast of Brazil. The first training course at UFBA in research methods took place in the fall of 2007 and trained 16 scientists from the region. Several of these scientists are in the process of fielding pilot research projects developed at this training.

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 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.

Increasingly HIV prevention specialists are focusing efforts on community social mobilization (CSM) strategies as a powerful and sustainable means of combating the HIV epidemic. This study aims to

• Develop a conceptual definition of CSM, including exploration of dimensions of CSM appropriate to the context of rural South Africa. We will conduct focus group discussions with young men and women and in-depth-interviews with community leaders in order to adapt and refine prior work conceptualizing the definition and dimensions of CSM to fit the rural South African context.
• Generate context-specific items that capture dimensions of CSM and evaluate the properties of the new community mobilization measure. We will generate a pool of items measuring the dimensions of CSM, pilot test the items among 100 young people, conduct exit surveys, and evaluate the scale properties in order to refine the measure for use in a large scale survey.
• Test the measure of CSM in the large scale community survey of young people aged 18-35 years (1,200 people in 25 communities) being implemented in the study entitled “Effects of cash transfer and community mobilization in young South African women.” The scale performance will be evaluated for reliability and validity using both item response modeling and confirmatory factor analysis in a large sample.

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).