India is estimated to have 5.1 million people living with HIV infection, making it second only to South Africa. A recent qualitative study by Tripathi found that alcohol consumption is common in several subpopulations who are also at high risk for HIV. In-depth interviews suggest that members of these groups may drink to cope with stress, to enhance pleasure and performance, and that their alcohol use may be related to HIV risk taking. Our quantitative research with male STD patients in Mumbai showed that men who reported sex with female sex workers under the influence of alcohol were also more likely to report unprotected sex with these partners. However, no data were obtained on alcohol or drug use patterns, the context of alcohol or substance use, or on expectancies. Thus, although the link between alcohol and HIV risk taking has been demonstrated in some Indian population groups and settings, very little is known about the nature of this relationship. The current study has been designed to meet this need. It utilizes the Information-Motivation-Behavior (1MB) model of health behavior, incorporating constructs from gender and empowerment theory, to guide the selection of study measures and the design of a pilot intervention. The study extends Tripathi's work to male migrant workers (MMW) and female sex workers (FSW) in South India. The proposed study will also build research capacity of Indian scientists and staff by involving two South Indian NGO scale-up partners of YRG Care;an established AIDS research organization in Chennai, Tamil Nadu. Specifically, we propose to recruit participants in Chirala, Andhra Pradesh and Calicut, Kerala to: 1. Examine qualitatively: a) patterns and contexts of alcohol consumption;b) sexual risk taking patterns;c) culturally- and population-specific factors;and d) the relationship between motivation, alcohol consumption, its social context and sexual behaviors among MMWs and FSWs in these settings. 2. Develop and administer a theory-driven, quantitative survey to measure a) the prevalence and patterns of sexual risk taking and alcohol consumption;b) sexual risk taking patterns, c) model-specific variables;and d) the relationship between sexual risk taking, type and context of alcohol consumption and other motivational, interpersonal, sociocultural and contextual variables in the target populations. 3. Develop, implement and pilot test a culturally-specific, theoretically-guided and empirically-based risk reduction intervention in collaboration with our Indian partners as well as with local and regional alcohol researchers, health care providers, public health officials and NGO representatives to reduce HIV risk taking in the context of alcohol use among South Indian sex workers and migrant workers.
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