The overall objective of the present study is to describe the potential for the spread of HIV/AIDS in the northern state of Uttar Pradesh, India (UP). UP, the most populous state of India, is characterized by conditions that have exacerbated the AIDS epidemic elsewhere: low socio-economic development, poor health outcomes particularly for women, and high gender stratification. The study's two consecutive phases will address the four specific aims: Phase I: Qualitative methods will be used to: 1) Develop a set of explanatory models to elucidate the combination of factors that place men in urban UP at risk for engaging in sexual bridging behavior; 2) inform the development of the male survey instrument for Phase II and aid the interpretation of Phase II results. Men who engage in bridging behavior will be identified from among clients of female sex workers and STD patients in the same cities selected for the Phase II population-based survey. In-depth, interviews with these men will focus on life history, peer groups, sexual networking, partner history, patterns of condom use, HIV/STD-related knowledge, and other factors. Qualitative analyses will identify factors and pathways of influence associated with behavior that places men at risk for becoming infected with and transmitting HIV infection. Phase II: A cross-sectional, population-based survey among couples of reproductive age in UP will be conducted to: 3) Investigate the patterns and determinants of HIV/STD-related knowledge, and perceptions of risk, and of related behavior that places them at risk for these infections, 4) identify and compare the determinants of married women's and men's health seeking behavior for symptoms of sexually transmitted diseases. A probability sample of 3,000 couples living in the two largest cities and a rural area in each of the five geographical regions that comprise UP will be drawn. Eligible women will be aged 14- 49, married, and residing with their husbands at the time of interview. Eligible men will be the spouses identified by eligible women. Data provided by wives and husbands will be linked and used in multivariate analyses to investigate the differentials between spouses in the patterns and determinants of the outcomes of interest, with a particular focus on the effects of women's autonomy and men's social support for their wives.
