Maharashtra has the highest HIV prevalence among the Indian states. Nagpur, an industrial hub in northern Maharashtra known for its red light district, has recently experienced a resurgence in HIV cases, yet it remains understudied. Interventions to reduce sexual risks among FSWs (female sex workers) are lacking in India, and they need to be brief to save costs and engage FSWs. This proposal will adapt a proven, theory- based behavioral intervention that promotes condom use to the culture and needs of FSWs in Nagpur.
Our specific aims are: 1) to conduct formative research to adapt an existing, efficacious sexual risk reduction intervention to the needs of FSWs in Nagpur, India;2) to determine, by means of a pilot study among FSWs in Nagpur, if the theory-based, single-session behavioral intervention resulting from Aim 1 is acceptable to FSWs, and to collect data at six-month follow-up to estimate effect sizes for a subsequent efficacy trial;3) to determine if theoretically important components of social cognitive theory and the theory of reasoned action (e.g., self-efficacy, intentions) and motivational interviewing techniques predict changes in FSWs'high-risk sexual practices;and 4) to explore personal, contextual, and psychosocial factors that are potentially associated with differential response to the intervention. To address Aim 1, we will modify and culturally adapt our existing, proven FSW intervention designed for HIV-negative Mexican FSWs. This formative research phase will last one year and will consist of in-depth, open-ended, qualitative interviews with various subgroups of Indian FSWs;counseling sessions with FSWs;piloting of all measures to assess relevance, appeal, gender and cultural sensitivity, presentation style and FSWs'willingness to implement intervention materials. After refining the intervention, to address Aim 2 we will pilot test our intervention protocol with 100 FSWs (50 HIV- positive and 50 HIV-negative) who will be randomly assigned either to a theory-based, 60-minute intervention that focuses on improving motivations for safer sex, use of condoms, and negotiation of safer sex, or to a time- equivalent didactic safer sex program. We will recruit a diverse sample of 100 FSWs from Nagpur who have had unprotected sex with at least one client during the previous month. Both groups will undergo interviews and HIV/STI testing at baseline and six-month follow-up. We hypothesize that the intervention arm will report reduced episodes of unsafe sex and will improve with respect to theoretically-important indicators of change (e.g., self efficacy for negotiating safer sex). While this pilot study will not have adequate power to detect changes in STIs, we will gather data on baseline and incident STIs in an effort to design and evaluate efficacy in a larger intervention trial. The development of a brief, practical and culturally relevant intervention to reduce HIV risks among FSWs in central India is critical to stem the burgeoning HIV epidemic in that country, and may have applicability to other resource-poor countries.
The health security of the general population in many countries is threatened by the growing incidence of HIV and other sexually transmitted infections among subpopulations that, for various social and economic reasons, engage in high-risk sexual behavior. This project seeks to adapt a counseling program that has been successful in reducing the risk behavior of certain high-risk groups in the U.S. (methamphetamine users) and Mexico (female sex workers) to the needs and circumstances of female sex workers in Nagpur, India, a group that has demonstrated high prevalence of HIV infection. If the adaptation proves successful, it could have significant impact on slowing or stopping the spread of HIV infection in this group and in the general population.
| Semple, Shirley J; Strathdee, Steffanie A; Srikrishnan, Aylur Kailasom et al. (2013) Social and behavioral characteristics of gharwalis who operate brothels in the Ganga-Jamuna area of Nagpur, India. AIDS Care 25:438-42 |
