This is a proposal for a midcareer investigator award in patient-oriented research (K24) for Dr. Carol Golin. Despite efforts to curb HIV spread, incidence continues to increase in the southern U.S. Behavioral programs that address risky sexual behavior and ARV adherence can improve HIV transmission-related health behaviors of individuals, but are limited. Interpersonal and community-level factors, such poverty, social norms, crime and incarceration rates, interpersonal stress, and dyadic capacity often drive or constrain vulnerability to HIV, and may impede effects of behavioral programs. There is an urgent need for a pipeline of beginning investigators, especially those from underrepresented groups, with the interest and skills to collaboratively address these factors. As Director of the UNC CFAR Social and Behavioral Science Core, Dr. Golin is increasingly called upon to mentor numerous promising young investigators seeking to work with her to obtain such skills. The proposed career development award will give Dr. Golin the dedicated time to expand and build her patient- oriented research in HIV/AIDS prevention by mentoring several talented junior colleagues at UNC in HIV prevention and adherence research. Dr. Golin aims to create a formal UNC Program on HIV Prevention in the US South by achieving four immediate goals, to: 1) enhance her capacity to evaluate structural determinants of health and cost-effectiveness of HIV prevention intervention programs through formal and informal training and collaboration; 2) extend her patient-oriented investigations (exploring the interface between motivation, self- efficacy, and risky sexual behavior) by examining the role of interpersonal and community-level determinants of the HIV epidemic in influencing the effectiveness of HIV prevention programs; 3) evaluate the cost- effectiveness of the Individuals Motivated to Participate and Adhere to Care and Treatment (imPACT) HIV prevention program; and 4) enhance her capacity to provide effective and outstanding mentoring to junior investigators. The patient-oriented research proposed in this application, which provides a vehicle for career development for Dr. Golin and her mentees, will: 1) Examine the moderating effects of interpersonal and structural factors on the SafeTalk program's effectiveness among heterosexual HIV-infected individuals; 2) Explore the views of heterosexual participants in the imPACT study and their social network members to assess dyadic and community factors that helped or impeded their use of adherence or safer sex strategies.; 3) Evaluate the cost-effectiveness of the imPACT program; 4) Explore potential neighborhood and dyadic contexts for HIV risk among HIV-negative women and their male partners living in high poverty, high HIV prevalence census tracts in in NC. Her long-term career objective is to grow the HIV Prevention Program she is developing to a fully established Center for creating, testing, and disseminating effective, comprehensive HIV prevention interventions for vulnerable communities throughout the Southeastern U.S.