6 “Because of our culture, because to us black people it’s a new thing that thing of using condoms . . . our partners they just told themselves that they will not use condoms, and he does not think about you.” (FGD—HIV-positive African women) 3.1.4. Socioeconomic Issues. Focus group participants spoke of current socioeconomic circumstances as a challenge to living positively with the virus. Likewise, KIs expressed con- cern that PLWHA might have other, more pressing, problems that they faced on a daily basis (like unemployment, poverty, domestic violence), so that in contexts where concerns regarding survival from day to day were paramount, HIV status could be considered secondary: “I would say we need to look at social upliftment, that’s a very important aspect, because some- times the core of your problem starts at social level.” (FGD—HIV-positive mixed race men and women) “People come because they are HIV-positive, they come to the support group, but many times the HIV status is almost secondary in the support group, it’s like a whole lot of other issues that come out about poverty and about unemployment, about domestic violence, about child support, just everything else but the HIV status.” (KII— Community Muslim AIDS support group) “Thabo [Mbeki, SA president] is dead spot on, poverty is our biggest issue here, you start dealing with poverty, suddenly people will start having a will to live, but if you live in a shithole, how the hell are you going to have the will to live . . . even in the support groups in [two local predominantly African areas] it wasn’t about that they were positive, it was about housing, food all other issues than HIV, so I mean, what I’ve learnt is that nine out of ten people have got so much shit on their plate before HIV arrives, that that’s the stumbling block.” (KII—Work-place AIDS education organisation) These ﬁndings suggest that in the context of unem- ployment, poverty, and lower socioeconomic status, HIV status becomes a secondary concern to PLWHA. In a study conducted in a black township in Cape Town, ﬁndings revealed that AIDS was only one of the major social stressors threatening people living in everyday poverty [40]. 3.2. Implications for the Adaptation of the Intervention Activities of Healthy Relationships. Data was used to ensure that all intervention materials were contextually relevant. We replaced the USA-developed movie clips with South African movie clips from popular local movies and television shows. A major innovation was to create storyboards using the movie clips for use in venues where there was no electricity and movie clips could therefore not be used. AIDS Research and Treatment Healthy Relationships makes extensive use of movie clips, story boards, and role plays in three of the ﬁve sessions. The purpose of making use of movie clips, story boards, and role plays is to elicit discussions about disclosure to family, friends, and sex partners and about risk reduction strategies. Therefore it is important that these activities are contextually relevant. Movie clips were selected based on the issues and challenges highlighted by focus group participants and KIs. For example in this study data revealed that AIDS-related stigma are not eradicated that it remains persistent, however, there was also a sense among KIs and focus group participants that it has decreased substantively. The data also revealed that AIDS-related stigma manifested diﬀerently across cultural groups. Closely related to this was the extent to which “othering” is still occurring. On the basis of this, a clip of PLWHA from diﬀerent cultural backgrounds speaking of their experiences of living with HIV and of AIDS- related stigma and their triumph over the management of the disease was selected for inclusion in the intervention package. This was also translated onto storyboards for the sessions that focus on disclosure. “Othering” was dealt with by the inclusion of an HIV/AIDS information session that dispelled some of the myths about HIV transmission that persisted in certain cultural groups. Secondly, a dominant outcome of experiences of stigma was reluctance to disclose HIV-positive status, for fear of being rejected by one’s spouse, sexual partner, or family members; losing one’s job; being ostracised in the com- munity. However, among focus group participants and KIs, the beneﬁts of disclosure were also recognised. These ﬁndings conﬁrm the need for issues of disclosure to be a central component of a risk reduction intervention for PLWHA. Previous studies have emphasised that disclosure of HIV-positive status is an integral part of behaviour modiﬁcation [41]. According to research, three behaviour domains identiﬁed as problematic for people living with HIV are condom use, negotiation of safer sex practices, and disclosure [42]. Condom use and negotiation of safer sex practices involve the issue of whether to disclose one’s serostatus to potential sex partners or not. Therefore, in the context of prevention of the further spread of HIV disclosure of HIV-positive status is important. With regards to the adaptation of Healthy Relationships, the intervention activities and disclosure content have to be sensitive to diﬀerences of experience across local com- munities (e.g., Muslims), in diﬀerent contexts (e.g., the work place), and for diﬀerent groups (e.g., those with same sex sexual orientations). Formative research of this nature provides an indication for positive prevention interventions as to which social and sexual contexts motivate disclosure decisions. What also needs to be taken into consideration for the adaption of the intervention is the encouraging fact that some participants indicated that disclosure was not always followed by rejection, but that it could also lead to support. A key issue emerging from the qualitative interviews was the central role that gender plays in dealing with HIV-positive status. This manifested in a number of ways: ﬁrstly, HIV-positive women were often stigmatised as being promiscuous; secondly, disclosure rendered women