As we enter the third decade of implementing HIV prevention interventions, the challenge of sustaining healthful behaviors promoted by these interventions remains to be met. By facilitating motivators and enablers of behaviors operating in the environment, structural interventions have the potential to promote this sustainability. Evidence suggests that intervening in the environment where risk behavior takes place rather than targeting an individual, may be an important structural intervention strategy. In India, such an environment is seen in wine shops or bars where alcohol use and sexual networks converge. 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, low access to health care; but when HIV/STD counseling and testing were offered, over 90% availed of this service. If this health seeking behavior can be sustained we can avert repeat and incident infection with HIV and sexually transmitted diseases (STDs). In the proposed study, we seek to use computer technology to modify the social and physical environment of the wine shop that will help patrons seek care for HIV/STDs. The widespread use of technology, particularly computers, in India, the prevalent expertise in software development and the willingness of wine shop businesses to collaborate on this project are factors that might facilitate feasibility and sustainability of this study. We will conduct research to develop appropriate games and educational modules for HIV/STD prevention and health care seeking, program these modules into computers and place them in wine shops. We will then establish linkages between wine shops and YRG CARE - a centrally located venue for HIV/AIDS care in Chennai to facilitate referrals initiated by management. We will use a pre-post-test design to evaluate a pilot of this intervention. , Our attempt is to institutionalize a working opinion leader led education model in Chennai that has shown to be efficacious elsewhere in a manner that is cost-effective, business and user friendly using content that is accepted and appreciated by wine shop patrons. By utilizing the strengths (in this case software development) of a developing economy such as India to address public health needs, this is an unique opportunity to address HIV prevention. Such an intervention, if feasible and acceptable will be important in bridging the gap between science and practice where structural interventions in HIV prevention are emphasized but few are implemented and evaluated. ? ? ? ?
