This proposal seeks to develop and evaluate a culturally appropriate, health facility-based intervention to promote primary prevention of HIV and other sexually transmitted infections (HIV/STIs) among married women, ages 18-40, living in an economically marginal community in Mumbai (Bombay), India. The proposal responds to the need to develop effective approaches to the global risk of husband to wife transmission of HIV/STIs. This proposed project utilizes an approach to HIV/STI risk reduction among married women that centers on culturally-based gynecological and related health symptoms that women feel more comfortable discussing and presenting for treatment.
The specific aims of this proposal are to: (1) Conduct formative research on the stakeholders and institutions involved in women's health including women in the context of the family, women as patients, husbands and their relationship to the health of their wives, and the nature of health care for women in the community;(2) Develop and implement, based on the formative research, Enhanced Care and Couples'Intervention in an existing public health facility to reduce women's HIV/STI risk within marriage;(3) Test the efficacy of the interventions, through a randomized clinical trial (RCT), to reduce the risk of HIV/STI transmission, to reduce STIs and women's gynecological and related symptoms and to improve women's life situation. The proposed project will be conducted in an urban """"""""slum"""""""" community of Mumbai. The project will be organized into three phases: Phase I (Year 1) will involve formative research on health and other service providers, married women, and married couples;analysis of these data;and finalization of the intervention design. Phase II (Years 2-4) involves the establishment of a randomized experimental design that will include: Enhanced Care plus Couples'Intervention;Enhanced Care Only;Standard of Care plus Couples'Intervention;and Standard of Care only;and Phase III (Year 2-5) will evaluate the impact of the interventions on married women. The great majority of women in the world are exposed to HIV/STI risk not through their own agency, but because of the behavior of their spouses. The intent of this study is to develop an approach that will reduce risk among vulnerable married women in these communities and thus serve as a model for India as well as for other vulnerable women in developing and developed countries.
