As we enter the third decade of HIV prevention, evidence suggests the important role of individual alcohol use in facilitating the risk of HIV and STD acquisition. With 2.5 million adults living with HIV, India, after Africa, has the highest burden of HIV infected persons. Alcohol use, particularly among men, is gaining increasing attention from HIV prevention programmers and policy makers here as a risk factor amenable to change. While the strength of and existence of the association between alcohol use and risky sex has been debated in the scholarly literature, what is clear is the need to address venues where alcohol is used as a locus for HIV prevention efforts. In India, wine shops - community- based alcohol outlets- hold potential for a venue-based intervention. Our team - Johns Hopkins and YRG Center for AIDS Research (YRG CARE) in Chennai, India - has been working in wine shops implementing an individual-focused opinion leader-led social norm change HIV prevention intervention (NIMH U10MH 681543-01) in Chennai since 2000. In this study, we found high burden of HIV among patrons - 3% (over nine times higher than the national rate of 0.3%);high rates (>50% of participants) of unprotected sex and alcohol use before sex and high levels of harmful alcohol use measured by more than five drinks per sitting (65%). We also found that venue patrons have minimal access to care for either HIV or alcohol use. Individual factors such as information of harmful drinking patterns, positive attitudes and towards seeking help and perceived drinking norms that have been shown to motivate care seeking and promote responsible alcohol use are little understood in India. Further, venue-level factors such as trained service staff, supportive alcohol serving policies, availability of care seeking and prevention tools such as referral information that have worked elsewhere are yet unexplored in India. This understanding is critical to obtain in wine shops as this is where high risk (for HIV and harmful alcohol use) patrons meet regularly and socialize. In this study, based on person-environment theory of behavior change, we seek to understand and modify the environment of the wine shop that will help patrons seek care for HIV/STDs and harmful alcohol use.
This intervention has high public health significance. By exploring the feasibility of a venue- based intervention using technology and server training in high risk alcohol use outlets, we hope to gather preliminary data that will further our understanding of the mechanics of targeting HIV prevention beyond the individual. We also propose to collaborate with the government to implement the first of its kind partnership to intervene in alcohol service venues in Chennai, India.