Downloaded from http://journals.lww.com/aidsonline by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 04/02/2021 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Formative study conducted in five countries to adapt the community popular opinion leader intervention NIMH Collaborative HIV/STD Prevention Trial Group M Objective: To obtain information about the social and cultural factors related to health behaviors influencing HIV/sexually transmitted disease (STD) transmission in study communities in China, India, Peru, Russia, and Zimbabwe so that the assessment and intervention of the National Institute for Mental Health (NIMH) Collaborative HIV/STD Prevention Trial could be adapted appropriately. Methods: Field observations, focus groups, in-depth interviews with key informants, and an observation of community social dynamics were conducted as part of a rapid ethnographic assessment. Results: All five sites reported a power dynamic tilted towards men, which rendered women particularly vulnerable to HIV and other STDs. Women’s relative lack of power was exemplified by a double standard for extramarital sex, women’s limited ability to negotiate sex or condom use, and sexual and physical violence against women. In all sites except Russia, extramarital sex is tolerated for men but proscribed for women. In Peru, power dynamics between men who have sex with men were tilted towards men who self-identified as heterosexual. Condom use (reported to be low across all sites) was often linked to having sex with only those perceived as high-risk partners. Regardless of site or study population, participants agreed on the following characteristics of an ideal community popular opinion leader (C-POL): respectable, credible, experienced (life and sexual), trustworthy, empathetic, well-spoken, and self-confident. Conclusion: The ethnographic studies provided critical information that enabled the study teams to adapt elements of the Trial in culturally appropriate ways in diverse international settings. ß 2007 Lippincott Williams & Wilkins AIDS 2007, 21 (suppl 2):S91–S98 Keywords: behavioral interventions, culture, ethnography, low-resource countries, qualitative data, risk factors, sexual behavior Introduction Researchers appreciate the need to understand the social and cultural factors related to health and illness in diverse settings because of the direct and indirect impact of these factors on exposure and vulnerability to disease, risk- taking and health promotion behaviors, and access to quality healthcare [1]. Ethnographic methods, including field observations, in-depth interviews, focus groups, and social mapping, provide an important set of tools for understanding the contextual features that elicit behaviors that are protective or damaging. Rapid ethnographic assessment is regularly applied in behavioral intervention research and programme evaluation [2–6]. In-depth interviews are particularly useful for exploring sensitive topics, such as sexual practices, sexual norms, and HIV- related risk behaviors, and providing explanations for quantitative findings [7,8]. To ensure that the intervention, the community popular opinion leader (C-POL), and assessment measures were culturally appropriate and acceptable, a rapid ethnographic assessment [2] was conducted before final protocol development for this five-country (China, India, Peru, Russia, and Zimbabwe) study. Using a standard set of methods, with operational definitions specified in the protocol, each research site collected data on the following core topic areas: (i) sexual health data; (ii) sexual practices and meanings; (iii) healthcare delivery and beliefs; (iv) social groups; (v) characteristics of C-POL (natural à See Appendix B for members of the NIMH Collaborative HIV/STD Prevention Trial Group. ISSN 0269-9370 Q 2007 Lippincott Williams & Wilkins S91