1. NIMH - R01 MH65163-01: Brazilian HIV Prevention for the Severely Mentally Ill - Translating Efficacious HIV Prevention Interventions for Institutional Settings: A Stakeholder Model of Cultural Adaptation M.L. Wainberg 1, P.L.E. Mattos 2, K.M. McKinnon 1, S. Oliveira-Broxado 2,C. Mann-Gruber 2 D. Pinto 2, D. Feijo 2, M.A. Gonzalez 1, C. Linhares 2, T. Dutra 2, R. Remien 1, F. Cournos 1,US-Brazil PRISMA Project 1, 2, 3 3 ABIA Associação Brasileira Interdisciplinar de AIDS www.abiaids.org.br abia@abiaids.org.br Issues Despite a well-documented AIDS crisis in Brazil and a government committed to HIV prevention, Brazilian people with severe mental illness (SMI) are not offered prevention interventions. The only efficacious interventions for the SMI were developed in the U.S. In this NIMH-funded US-Brazil collaboration study we sought to: 1.Conduct research using ethnography to determine culturally appropriate adaptations to extant efficacious HIV prevention intervention content and format; 2.Establish a process that facilitates interdisciplinary and intercultural collaboration in adapting and integrating efficacious sources, and developing a prevention intervention for psychiatric patients in Brazil; 3.Balance fidelity with fit in determining modifications to extant efficacious HIV prevention interventions. Our goal is to test the Brazil intervention’s feasibility and, ultimately, its efficacy. Description We conducted ethnographic observations in psychiatric settings and focus groups and key-informant interviews with patients and providers: a) Local SMI are sexually active, use condoms infrequently, are comfortable talking about sex, want to learn HIV prevention skills; and b) Providers address HIV prevention idiosyncratically and there is need for systematic HIV prevention interventions and training. We elicited participation by a Project Advisory Board composed of local NGOs, individuals with HIV or with SMI, and community leaders to determine needed adaptations to extant U.S. interventions. We trained 20 mental health care providers (MHCP) and convened for three 3-day workshops to create culturally appropriate variations (fit) of intervention content, themes, and message delivery strategies while preserving core concepts from efficacious interventions (fidelity). 1 HIV Center for Clinical and Behavioral Studies New York State Psychiatric Institute Columbia University mlw35@columbia.edu 2 Instituto de Psiquiatria Universidade Federal do Rio de Janeiro Brazil mattos@attglobal.net Lessons Learned Formative work in Brazil showed that stakeholders (patients and providers) were eager to share knowledge, identify problems, and overcome gaps in institutional efforts at HIV prevention among psychiatric patients. It is difficult to know to what extent RCT prevention interventions are generalizable to new settings, cultures, countries, populations. The presumption is that the particulars of an intervention are manifestations of its underlying theoretical model. In this case the RCTs were grounded in cognitive- behavioral theory, not the dominant theory of change in Brazil which has a long history of theater of the oppressed and psychodynamic theories. Preserving fidelity required coming to agreement about whether these models could be made to work together. Our process of was sensitive to these differences and the MHCPs training and workshops included specific education and discussion of the principles from both to be adhered to in the development of the Brazil intervention. Adaptation and integration of sources requires negotiation as to how much content or delivery strategies can be changed so as to fit with the local needs, values, and priorities of the intervention users. Stakeholder participation provides invaluable information and strengthens the degree of commitment of all parties to achieve the goals of research. Team cohesion is important to establish, maintain, and reinforce and undergoes a process which parallels the group process that intervention participants experience; team awareness of this parallel is essential. Recommendations 1.Mutual capacity building in qualitative and quantitative research methods allows progress toward research and service implementation goals. 2.Balancing fidelity and fit is an essential intervention adaptation task. 3.Stakeholders’ input and participation in the adaptation and integration process to develop a local intervention, PRISSMA, may facilitate acceptability, dissemination, and integration of HIV prevention programming into the mental health care system in Brazil.