Preventing Rural Thai Methamphetamine Abuse and HIV by Community Mobilization

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DESCRIPTION (provided by applicant): This revised competing continuation application of R01 DA14702-01 continues our behavioral interventions to reduce adolescent and young adult HIV sexual risks associated with non-injection methamphetamine use in northern Thailand. During the first five years of our grant, we characterized variation in MA use and sexual risks for HIV acquisition. In 2004, we started study procedures and enrollment was completed (n=987) in May 2006; data collection ends in July 2007. We have had excellent recruitment, participation and retention (>90%) in the trial and we now shift our focus to remote, rural areas. Ethnography shows MA and other non-injection drug use is pervasive among rural youth and associated with HIV risk. We seek to prevent MA abuse and HIV risk by promoting community-level structural interventions developed by and with the affected communities. Our specific aims are: (1) to follow the Connect to Protect (C2P) approach to promote community mobilization, community capacity building, and community involvement to forge structural changes leading to decreased MA and other non-injection drug use risks for HIV acquisition. (2) to conduct a cluster-randomized trial of C2P over 3 years in 5 community clusters of 25 villages and compare its efficacy in MA and sexual risk reduction compared to 25 villages in 5 nearby community clusters that offer referrals for HIV VCT referrals. HIV and STI incidence, drug and sex risks, and stigma will be assessed in cohorts before and for two 15 month intervals after C2P mobilization. Finally, (3) within experimental communities, to evaluate components of the C2P intervention that generate behavior change using qualitative process evaluation data. Ethnography in targeted communities will determine local priorities for mobilization, capacity building and involvement. We will recruit 40 randomly selected community dwellers aged 14-29 years of age from each of 50 selected communities to participate in a cohort study (n=2000) to systematically determine risk. We will conduct a statistical evaluation of process and ethnographic data on components of the interventions associated with reductions in community-level MA risk. The proposed study takes a successful theoretically grounded approach from the USA to confronting problems experienced by youth at the community level in Thailand, and it promotes this model in an international setting. This project proposes a community-level behavioral intervention to reduce adolescent and young adult HIV sexual risks associated with non-injection methamphetamine use in northern Thailand. We will use an approach to community mobilization, community capacity building, and community involvement to forge structural changes leading to decreased MA and other non-injection drug use risks for HIV acquisition that has been used in the USA to respond to community-identified youth drug problems.