This application seeks to address the difficult problem of engaging males in reproductive health education, sexual risk reduction, and early treatment of HIV/STD in urban communities in India, a country where HIV/STD rates are increasing at a dramatic rate. We propose to develop, test, implement and evaluate an intervention that is centered on culturally defined male sexual health concerns about masculinity, vitality, sexual performance and fertility. A majority of men in India define their sexual problems, including symptoms that correspond to STDS, in these traditional concerns. Furthermore, men's sexual health concerns are linked to symptoms of STDs and risky lifestyle. However, public health providers' inattention to and lack of respect for these problems cause men to avoid allopathic services and seek treatment for sexual health problems mostly from unqualified practitioners. Any reproductive health service in India that hopes to introduce early identification of STDs/HIV in men and to increase safer sex practices must start by addressing these male sexual health concerns. This project seeks to test the propositions that traditional male concerns predict higher rates of HIV/STD; determine the degree to which an intervention based on culturally based sexual health concerns can attract men into HIV/STD education and risk reduction and is effective for promoting positive social, psychological and health outcomes, including reduced risk and incidence of HIV/STDs; and test the differential impact of the intervention implemented by allopathic versus traditional sex doctors. This work will be carried out in three large urban slum communities in the northeastern part of Mumbai in the State of Maharasthra, the epicenter of HIV/AIDS in India. This project is a collaboration of researchers at the University of Connecticut School of Medicine and the Institute for Community Research in the United States and the International Institute for Population Sciences in Mumbai (Bombay), India. The project will use both qualitative and quantitative methods in a pre-test, post-test control group design to examine the impact at community and patient levels. The study's significance lies in bringing together researchers and interventionists to address the challenge of developing methods for utilizing cultural factors in HIV/STD risk reduction and in developing the scientific and policy results, which can provide the basis for scaling up at the national and international level.
