Development of an opinion leader-led HIV prevention intervention among alcohol users in Chennai, India.
ABSTRACT 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.
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ABSTRACT: T he first case of HIV in India was detected in 1986. 1 Since then, over five million adults in India have been infected with HIV. 2 While this number in a population of over a bil-lion individuals translates to a low overall prevalence rate, the epidemiology of HIV infection suggests the need for focused prevention interventions that can avert large numbers of new infections. India is a country with a population of 1.02 billion individuals residing in thirty-five states and union territories. 3 Of these residents, 82% reside in rural areas. HIV infections have been reported in all states and territories, with the highest numbers reported from the southern states of Tamil Nadu and Karnataka and from the western state of Maharashtra. Heterosexual transmission is the dominant mode of transmission, accounting for 85% of infections. 2 Het-erosexual risk is reported from all Indian states, and data from sexually transmitted disease (STD) clinics in the community suggest an increasing prevalence of HIV among STD patients. National HIV pre-vention campaigns focus on messages ap-pealing to individuals to adopt safe sexual behaviors. 2% of infections nation-wide are attributed to injecting drug use. 2 While Sudha Sivaram, DrPH, MPH, is an Assistant Scientist with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. She has been involved in HIV research and program implementation in India for over 15 years. Carl Latkin, PhD, is Professor of Social and Behavioral Sciences, Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. Dr. Latkin is a social psychologist with extensive experience in HIV prevention interventions, network analysis and high-risk communities (drug and alcohol users). Suniti Solomon, MD, is Founder and Director of the YR Gaitonde Center for AIDS Research and Education (YRGCARE), which is a leading provider of education, care and support for persons and families living with HIV/AIDS in India. David D. Celentano, ScD is Professor and Director of the Infectious Disease Epidemiology program in the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health with joint appointments in International Health, Environmental Health Sciences and Health Policy & Management. His research integrates behavioral science theory and research with epidemiology, in the study of behavioral and social epidemiology.
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ABSTRACT: Although reported condom use between female sex workers and their clients is high in Ethiopia, condom use with regular, non-paying partners remains low, posing a substantial risk of HIV infection to sex workers, their partners and the general population. Previous studies have identified the synergistic effects of substance abuse, violence and HIV risk, but few have examined these inter-relationships among female sex workers and their regular, non-paying partners. This study explored the associations between work-related violence, alcohol abuse and inconsistent condom use among establishment-based female sex workers and their regular, non-paying partners in Adama City, Ethiopia. A cross-sectional survey was conducted with 350 establishment-based female sex workers, aged 15--35, at 63 bars, hotels and nightclubs. Multivariate logistic regression analysis was conducted to test the association between work-related violence and condom use with regular, non-paying partners, controlling for age, overall income, education and sex workers' total number of sexual partners in the past week. Alcohol abuse was explored as an effect modifier. Respondents reported a high prevalence of work-related violence (59%) and alcohol abuse (51%). Work-related violence was statistically significantly associated with unprotected sex with regular, non-paying partners among those who abused alcohol (OR: 6.34, 95% CI: 2.43-16.56) and among those who did not (OR: 2.98, 95% CI: 1.36-6.54). Alcohol abuse was not associated with inconsistent condom use within these partnerships, though it may strengthen the effect of work-related violence on unprotected sex. Findings suggest violence against establishment-based female sex workers is associated with HIV risk within regular, non-paying partnerships. Qualitative work is needed to better understand the links between a violent work environment and condom use with regular, non-paying partners and how interventions can be implemented in this context to prevent violence against sex workers and reduce HIV transmission.BMC Public Health 08/2013; 13(1):771. DOI:10.1186/1471-2458-13-771 · 2.32 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: Community-engaged research approaches involve members of the community in various aspects of a research endeavor to improve the health of populations. Engaging the community in research is important in the development, dissemination, and evaluation of new interventions, technologies, and other medical advancements to improve population health globally. A review of published community-engaged research studies conducted in India was performed. Fifteen published studies were identified and reviewed to evaluate the state of community-engaged research in India. The review indicated that community-engaged research in India is limited. Most published community-engaged research focused on health promotion, especially in the prevention or management of HIV/AIDS and other STIs. Community members were involved in a variety of aspects of the research, but there was not one published article indicating that community members had defined the disease of focus. Community-engaged research often led to valuable insights into the views, experiences, and behaviors of community members and also led to increased community participation in health initiatives. It is anticipated that future community-engaged research will lead to improvements in global health through increased empowerment of communities and a better ability to implement new and innovative medical advances, technologies, and interventions.04/2012; 13(4). DOI:10.3727/194982412X13292321140886