This is a proposal to understand the behavioral consequences of increased access to anti-retroviral therapy (ART) among HIV infected married men in South India and to do formative studies, which will ultimately lead to developing a behavioral intervention to promote secondary prevention. The proposed research will first involve conducting quantitative and ethnographic research to understand unsafe sexual practices among HIV-infected married men in Chennai, South India. Currently India has over 5 million individuals with HIV/AIDS. With the advent of highly active anti-retroviral therapy (HAART) in the developed world, deaths related to HIV have dropped and the number of patients living with HIV has continued to increase. As HIV treatment increasingly becomes available and accessible in India, risk reduction may appear less necessary among people with HIV. The future reduction of HIV transmission in India will require new strategies that emphasize prevention of transmission by HIV-infected persons. This study will lead to recommendations for incorporating HIV behavioral preventions into the medical care of HIV infected individuals in India. The proposed study will access behavioral modules based on a secondary prevention intervention for high risk HIV populations in the United States that can be selectively applied to an Indian setting. It is hoped that the development of a culturally-sensitive behavioral intervention coupled with antiretroviral treatment among HIV infected individuals will decrease the spread of the HIV epidemic.
The first aim will identify predicators of sexual risk among HIV infected married men who are currently undergoing antiretroviral therapy and who are not undergoing antiretroviral therapy cross-sectionally. The study will then determine psychosocial, behavioral, and biomedical variations among HIV infected married men and assess whether to focus a secondary prevention intervention on specific characteristics. Additional data will be collected as necessary for developing a secondary behavioral intervention integrated into HIV treatment to reduce unsafe sexual behavior among HIV infected married men tailored to an Indian sociocultural setting. The relevance to public health will involve examining the possibilities of integrating secondary prevention into routine HIV community treatment settings. This study will explore the current availability of HIV prevention strategies, such as voluntary counseling and testing (VCT), and access which aspects may be relevant as part of culturally relevant secondary risk reduction strategies in India. This study will assess the cultural relevance and feasibility of implementing a counseling condition based on models addressing information, motivation to change, and behavioral skills training for an Indian social and clinical setting.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Individual Predoctoral NRSA for M.D./Ph.D. Fellowships (ADAMHA) (F30)
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Special Emphasis Panel (ZRG1-AARR-G (03))
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Stoff, David M
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Brown University
Internal Medicine/Medicine
Schools of Medicine
United States
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Venkatesh, Kartik K; DeLong, Allison K; Kantor, Rami et al. (2013) Persistent genital tract HIV-1 RNA shedding after change in treatment regimens in antiretroviral-experienced women with detectable plasma viral load. J Womens Health (Larchmt) 22:330-8
Venkatesh, Kartik K; de Bruyn, Guy; Lurie, Mark N et al. (2012) Sexual risk behaviors among HIV-infected South African men and women with their partners in a primary care program: implications for couples-based prevention. AIDS Behav 16:139-50
Venkatesh, Kartik K; Mayer, Kenneth H; Carpenter, Charles C J (2012) Low-cost generic drugs under the President's Emergency Plan for AIDS Relief drove down treatment cost; more are needed. Health Aff (Millwood) 31:1429-38
Venkatesh, Kartik K; Srikrishnan, A K; Safren, Steven A et al. (2011) Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery. AIDS Care 23:722-33
Kumarasamy, N; Venkatesh, Kartik K; Devaleenal, Bella et al. (2011) Safety, Tolerability, and Efficacy of Second-Line Generic Protease Inhibitor Containing HAART after First-Line Failure among South Indian HIV-Infected Patients. J Int Assoc Physicians AIDS Care (Chic) 10:71-5
Venkatesh, Kartik K; Madiba, Precious; De Bruyn, Guy et al. (2011) Who gets tested for HIV in a South African urban township? Implications for test and treat and gender-based prevention interventions. J Acquir Immune Defic Syndr 56:151-65
Venkatesh, Kartik K; de Bruyn, Guy; Marinda, Edmore et al. (2011) Morbidity and mortality among infants born to HIV-infected women in South Africa: implications for child health in resource-limited settings. J Trop Pediatr 57:109-19
Venkatesh, Kartik K; Swaminathan, Soumya; Andrews, Jason R et al. (2011) Tuberculosis and HIV co-infection: screening and treatment strategies. Drugs 71:1133-52
Venkatesh, Kartik K; Flanigan, Timothy P; Mayer, Kenneth H (2011) Is expanded HIV treatment preventing new infections? Impact of antiretroviral therapy on sexual risk behaviors in the developing world. AIDS 25:1939-49
Mayer, Kenneth H; Venkatesh, Kartik K (2011) Interactions of HIV, other sexually transmitted diseases, and genital tract inflammation facilitating local pathogen transmission and acquisition. Am J Reprod Immunol 65:308-16

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