This is a proposal to understand the behavioral consequences of increased access to anti-retroviral therapy (ART) among HIV infected married men in South India and to do formative studies, which will ultimately lead to developing a behavioral intervention to promote secondary prevention. The proposed research will first involve conducting quantitative and ethnographic research to understand unsafe sexual practices among HIV-infected married men in Chennai, South India. Currently India has over 5 million individuals with HIV/AIDS. With the advent of highly active anti-retroviral therapy (HAART) in the developed world, deaths related to HIV have dropped and the number of patients living with HIV has continued to increase. As HIV treatment increasingly becomes available and accessible in India, risk reduction may appear less necessary among people with HIV. The future reduction of HIV transmission in India will require new strategies that emphasize prevention of transmission by HIV-infected persons. This study will lead to recommendations for incorporating HIV behavioral preventions into the medical care of HIV infected individuals in India. The proposed study will access behavioral modules based on a secondary prevention intervention for high risk HIV populations in the United States that can be selectively applied to an Indian setting. It is hoped that the development of a culturally-sensitive behavioral intervention coupled with antiretroviral treatment among HIV infected individuals will decrease the spread of the HIV epidemic.
The first aim will identify predicators of sexual risk among HIV infected married men who are currently undergoing antiretroviral therapy and who are not undergoing antiretroviral therapy cross-sectionally. The study will then determine psychosocial, behavioral, and biomedical variations among HIV infected married men and assess whether to focus a secondary prevention intervention on specific characteristics. Additional data will be collected as necessary for developing a secondary behavioral intervention integrated into HIV treatment to reduce unsafe sexual behavior among HIV infected married men tailored to an Indian sociocultural setting. The relevance to public health will involve examining the possibilities of integrating secondary prevention into routine HIV community treatment settings. This study will explore the current availability of HIV prevention strategies, such as voluntary counseling and testing (VCT), and access which aspects may be relevant as part of culturally relevant secondary risk reduction strategies in India. This study will assess the cultural relevance and feasibility of implementing a counseling condition based on models addressing information, motivation to change, and behavioral skills training for an Indian social and clinical setting.
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