In 1999, we began a community-based randomized controlled prevention trial in Chennai, which aims to test the efficacy of HIV prevention messages disseminated through members of an individual's social group called community popular opinion leaders, or CPOLs. We targeted patrons of 100 bars or wine shops in the city of Chennai, India. In this article we report on the process of development of an HIV prevention intervention for wine shop patrons. First, we conducted detailed ethnography to understand social norms and CPOL and social network characteristics, including 41 in-depth interviews among wine shop patrons and gatekeepers. Second, we tailored a generic HIV education training manual to appropriately address the needs of Chennai wine shop patrons. Field-testing involved 16 focus groups with wine shop patrons and 12 sessions of participant observations in wine shops. Finally, we piloted the intervention to determine the appropriateness of the training program and its content among wine shop patrons. Our ethnographic data indicated that wine shops are a common meeting place for men. We were able to identify CPOLs influential in these settings and train them to deliver appropriate prevention messages to their close friends and associates. We found that HIV prevention messages in this population need to dispel misperceptions about HIV transmission, provide strategies and skills to adopt and sustain condom use, and target the role of alcohol in sexual behavior. We outline specific lessons we learned in intervention development in this population.
"A study in England reported FSWs' willingness to engage in hazardous drinking for more money (Gossop et al., 1995). In Chennai, India, clients brought alcohol for FSWs to drink to meet their sexual demands and fantasies (Sivaram et al., 2004). A study in Armenia reported that 24% of FSWs were forced by clients to use alcohol prior to sex (Markosyan et al., 2007). "
[Show abstract][Hide abstract] ABSTRACT: To review the patterns, contexts and impacts of alcohol use associated with commercial sex reported in the global literature.
We identified peer-reviewed English-language articles from 1980 to 2008 reporting alcohol consumption among female sex workers (FSWs) or male clients. We retrieved 70 articles describing 76 studies, in which 64 were quantitative (52 for FSWs, 12 for male clients) and 12 qualitative.
Studies increased over the past three decades, with geographic concentration of the research in Asia and North America. Alcohol use was prevalent among FSWs and clients. Integrating quantitative and qualitative studies, multilevel contexts of alcohol use in the sex work environment were identified, including workplace and occupation-related use, the use of alcohol to facilitate the transition into and practice of commercial sex among both FSWs and male clients, and self-medication among FSWs. Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infections and unprotected sex among FSWs were inconclusive.
Alcohol use in the context of commercial sex is prevalent, harmful among FSWs and male clients, but under-researched. Research in this area in more diverse settings and with standardized measures is required. The review underscores the importance of integrated intervention for alcohol use and related problems in multilevel contexts and with multiple components in order to effectively reduce alcohol use and its harmful effects among FSWs and their clients.
Alcohol and Alcoholism 02/2010; 45(2):188-99. DOI:10.1093/alcalc/agp095 · 2.89 Impact Factor
"This suggests that the current media messages and campaigns to promote condom-use might need to expand on the ‘Use condoms’ (34) or ‘Be safe’ messages (35). Barriers—individual and structural—to condom-use need to be better understood, and strategies to motivating individuals to use condoms despite these barriers that are being employed elsewhere in India (36) might be applicable to this and similar rural populations in India. The role of structural factors is also highlighted in the bivariate analysis of this study where we observed that those with higher income and education cited past behaviours and being sick as reasons for care-seeking. "
[Show abstract][Hide abstract] ABSTRACT: This study sought to describe the development of HIV counselling and testing services in a rural private hospital and to explore the factors associated with reasons for seeking HIV testing and sexual behaviours among adults seeking testing in the rural hospital. Data for this study were drawn from a voluntary counselling and testing clinic in a private hospital in rural Andhra Pradesh state in southern India. In total, 5,601 rural residents sought HIV counselling and testing and took part in a behavioural risk-assessment survey during October 2003-June 2005. The prevalence of HIV was 1.1%. Among the two reported reasons for test-seeking--based on past sexual behaviour and based on being sick at the time of testing--men, individuals reporting risk behaviours, such as those having multiple pre- and postmarital sexual partners, individuals whose recent partner was a sex worker, and those who reported using alcohol before sex, were more likely to seek testing based on their past sexual behaviour. Men also were more likely to seek testing because they were sick. The findings from this large sample in rural India suggest that providing HIV-prevention and care services as part of an ongoing system of healthcare-delivery may benefit rural residents who otherwise may not have access to these services. The implications of involving the private sector in HIV-related service-delivery and in conducting research in rural areas are discussed. It is argued that services that are gaining prominence in urban areas, such as addressing male heterosexual behaviours and assessing the role of alcohol-use, are equally relevant areas of intervention in rural India.
Journal of Health Population and Nutrition 01/2009; 26(4):431-41. DOI:10.3329/jhpn.v26i4.1885 · 1.04 Impact Factor
"). Typically, alcohol prevention programs occur within a specific setting, such as bath houses or wine shops (Latkin & Knowlton, 2005; Sivaram et al., 2004) where the likelihood of alcohol use and sexual risk taking could be high or the programs may be directed towards individuals at risk of alcohol consumption, such as those in alcohol rehabilitation programs or youth in schools (Karnell et al., 2006). Given that unsafe sex in a given situation is not just related to alcohol consumption, reducing alcohol use may not eliminate the high risk behavior once it has been established. "
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