2 impacting more people at one time than the individually administered Options for Health intervention should also be tested. Indeed, there is one evidence-based risk reduction intervention which was originally developed in the USA known as Healthy Relationships [16, 17]. Healthy Relation- ships, is suitable for small groups and is a support group- based intervention that assists PLWHA to manage AIDS stigma, make eﬀective HIV status disclosure decisions, and practice lifelong safer sex. The intervention demonstrated evidence for eﬃcacy in a randomized controlled trial (RCT) conducted in the USA [16, 17]. Subsequently the USA’s Centers for Disease Control and Prevention (CDC) devel- oped Healthy Relationships as part of its Dissemination of Eﬀective Behavioral Interventions (DEBI) initiative. Healthy Relationships has now been implemented in more than 300 agencies in the USA. The intervention is broadly based on social cognitive theory. In its original form it was administered in ﬁve 3- hour sessions. The programme is designed to teach some generic skills which are used to help reduce participants’ stress related to safer sexual behaviours and disclosure of their serostatus to family, friends, and sexual partners. The intervention is highly interactive and promotes discussion between group members by using modelling, role-play, and feedback to teach and practice skills (e.g., problem-solving and assertive listening) related to coping with stress; provid- ing personal feedback reports to motivate behaviour change and the use of movie clips to set up scenarios about disclosure and risk reduction to stimulate discussions and role-plays [16]. Six group facilitators with a minimum requirement of a basic social science degree with previous experience of counselling and/or group facilitation were recruited. Group facilitators underwent a ﬁve-day intensive training session where each day was spent on each intervention session. Training consisted of primarily role plays of each session and was facilitated by a counsellor, who was trained by the developer of the intervention. Since Healthy Relationships was originally developed for use in the USA, some of the intervention activities (movie clips, role plays, risk reduction activities) might not be contextually relevant and appropriate for use with PLWHA in Southern African countries. Our research team working together with its partners in the Social Aspects of HIV/AIDS Research Alliance (SAHARA) collected formative data to culturally adapt Healthy Relationships for use in Botswana, Mozambique, Lesotho, and South Africa. Understanding the contextual factors that inﬂuence risk-taking behaviour is important since it is within this social context that PLWHA manage risk taking behaviour, negotiate for safer sex, and navigate their everyday lives. Hence formative research was used to explore the social contexts of PLWHA living in Cape Town, South Africa. The ﬁndings from this study were used to primarily inform the cultural adaptation of the major intervention activities like the movie clips, role plays, and risk reduction activities to Southern African context. This phase of the study was the ﬁrst part of a larger research project to evaluate the eﬃcacy of a culturally adapted Healthy Relationships risk reduction intervention in Southern Africa. AIDS Research and Treatment 2. Methodology A qualitative study was conducted as part of formative research for the cultural adaptation of Healthy Relationships to the Southern African context. For this study, 14 key informants (KIs) were interviewed, seven of whom were aﬃliated to support groups for PLWHA and others, and the other seven represented nongovernmental organisations (NGOs), activist groups, government departments, or train- ing services. In addition, eight focus group discussions (FGDs) were held with existing support group structures that are situated at either ARV sites or organisations that provide services to PLWHA. Access to these support groups was obtained through some of the key informant participants. Focus group participants were 18 years and older, HIV- positive, and belonged to already existing support groups for PLWHA. Three mixed-sex and ﬁve single-sex groups participated in the FGDs. The total number of participants for these focus groups was 83. Group participants were primarily recruited from support groups based in working class communities and townships in and around Cape Town. Focus groups consisted of men (both heterosexual and same sex) and women from mostly black African and mixed race sociocultural backgrounds in nontreatment linked support groups, men and women from support groups of PLWHA who are on ARV treatment, a white, gay men’s support group, and pregnant women from the Mothers-to- Mothers-to-Baby (M2M2B) support groups. Demographic information was not collected from focus group partici- pants. KI interviews and FGDs were conducted by PLWHA who are open about their HIV-positive status. Interviewers were trained in qualitative interviewing skills and in facilitation of group discussions. KI interviewers and group facilitators followed an interview guide. Appointments were made with KIs and interviews were held at venues suitable for KIs. FGDs were held at the venues where the participants usually met for their support group meetings. Group discussions were conducted in the language of choice of the participants. Issues explored in both the individual and group interviews included the challenges facing PLWHA as well as their experiences of the value of and need for support groups. KI interviews and FGDs were audio-recorded. The audio tapes were then transcribed verbatim, and translated where necessary. Data were analysed using thematic analysis. The fol- lowing steps were taken to analyse the data: transcripts were coded using the participants’ own words and phrases and without preconceived classiﬁcation; the participants’ language or phrases were examined, categorised, and recur- rent themes were identiﬁed. Recurrent themes are the similar and consistent ways people think about, and give accounts concerning particular issues [18]. Examples of repetition, explanation, justiﬁcation, and vernacular terms were highlighted. These were then coded with a key word or phrase that captured the essence of the content, and were taken to constitute emergent themes [19, 20]. All participants in this study took part voluntarily and anonymously, and signed consent forms beforehand. Ethical