HIV Behavioral Disinbition Risk Reduction for Recently Circumcised South Africa M

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DESCRIPTION (provided by applicant): Male circumcision (MC) reduces the risk for HIV infection among men in South Africa. Although the protective value of MC for HIV prevention is now undisputable, there is evidence that the preventive benefits of MC could be offset by reductions in condom use and increases in numbers of sexual partners. Although there are substantial concerns about the risks for behavioral disinhibition, or risk compensation, following MC, there are no theory-based behavioral interventions designed to reduce behavioral disinhibition. The proposed research will perform rapid intervention development activities in response to the urgent need for behavioral disinhibition prevention interventions for men who undergo MC in southern Africa. Formative interviews with circumscribed men and circumcision providers will inform an intervention development workshop through which we will formulate an adapted brief risk reduction intervention. The adapted risk-reduction counseling will be pilot tested for feasibility, acceptance, and potential efficacy. The adapted intervention will be a direct extension of a risk- reduction counseling intervention that we are currently testing in three South African clinics. The counseling model will be specifically tailored to reduce risk compensatory behaviors / behavioral disinhibition that may follow MC. Should we find the adapted risk-reduction counseling intervention acceptable, feasible, and potentially efficacious, we will propose to test it in a rigorous randomized trial. Male circumcision (MC) reduces HIV transmission risks and could potentially alter the course of AIDS in Africa. Unfortunately, the benefits of MC for HIV prevention could be offset by behavioral disinhibition - reductions in condom use and increases in numbers of sex partners following MC. The need for behavioral risk reduction counseling in conjunction with MC is widely recognized. However, there are no behavioral interventions adapted for use with men who undergo MC for HIV prevention. This research offers a unique and economical opportunity to adapt an intervention that has already demonstrated efficacy for HIV risk reduction with African men for use in the context of MC. Once completed, this intervention and all of its material will be readily available for further research and implementation.