This capacity-building study involves collaborations between an interdisciplinary team of Indian and United States (US) researchers, and it is designed to test hypotheses regarding risk factors for HIV infection in Goa, India. Recent research by our team, that includes ongoing work in India, suggests that heavy drinking significantly increases health risks, including risky relationship behaviors. The study will include detailed assessment of overall alcohol consumption patterns (not only average volume) and their association with risky behaviors known to increase risk for HIV infection (such as having relationships with high-risk partners or violence). An intensive formative measurement-refinement phase will include key informants, focus groups and depth interviews with small samples. Measure selection will be informed by methodological work in the US and India. These efforts will enhance survey and daily diary measures and adapt them for use in Goa to account for local cultural circumstances. Following this, established alcohol screeners validated in India (AUDIT and RAPS4) will be used to select urban and rural community samples of 500 men and 500 women in each of two communities (total N = 2,000). These samples, comprised three-fourths of both women and men current drinkers, including over samples of hazardous drinkers, will complete a detailed survey. A selected population at elevated risk will be studied in more depth. Specifically, 30 men and 30 women heavy drinkers who also report risky behaviors will be studied using 28-day prospective event-based diaries and qualitative depth interviews. A unique feature of the study is the triangulation of multiple methods to examine relationships between drinking and risk behaviors. Using culturally adapted measures, the study investigates specific risks associated with components of the drinking pattern hypothesized to elevate likelihood of risky behaviors, such as drinking contexts and alcohol-related problems. Relationships will be examined while estimating and statistically adjusting for additional variables, like personal characteristics such as impulsivity and notions about relationships and gender, expected to be influential on the basis of earlier research both in the US and in India. The study tests hypotheses about various relationships among a set of predisposing and temperament variables, expectancies, attitudes, and patterns of alcohol consumption and problems, with risks as the dependent variable. Risk analyses will inform the epidemiology of HIV risk behaviors in India and provide a rich source of information for planning preventive interventions in a resource-poor society.
