Using Technology to Prevent HIV in Indian Wine Shops

描述（由申请人提供）：随着我们进入艾滋病毒预防的第三个十年，有证据表明个人饮酒在促进艾滋病毒和性病获得风险方面的重要作用。印度有250万成年人感染艾滋病毒，是艾滋病毒感染者负担最重的国家，仅次于非洲。饮酒，特别是男性饮酒，作为一个容易改变的风险因素，越来越受到艾滋病毒预防方案制定者和决策者的关注。虽然学术文献中对饮酒与危险性行为之间的联系的强度和存在进行了辩论，但显然需要解决将饮酒作为艾滋病毒预防工作场所的问题。在印度，葡萄酒商店-以社区为基础的酒类销售点-有可能采取以场所为基础的干预措施。我们的团队-约翰霍普金斯和印度金奈的YRG艾滋病研究中心（YRG CARE）-自2000年以来一直在金奈的葡萄酒商店实施以个人为中心的意见领袖领导的社会规范改变艾滋病预防干预（NIMH U10 MH 681543-01）。在这项研究中，我们发现顾客的艾滋病毒负担很高- 3%（比全国0.3%的比率高出9倍多）;高比率（>50%的参与者）无保护的性行为和性行为前饮酒以及高水平的有害酒精使用，每次饮酒超过5杯（65%）。我们还发现，场馆顾客获得艾滋病毒或酒精使用护理的机会最少。在印度，人们对有害饮酒模式的信息、积极的态度和寻求帮助的态度以及已被证明能激励寻求护理和促进负责任饮酒的饮酒规范等个人因素知之甚少。此外，印度尚未探索场所一级的因素，如训练有素的服务人员，支持性的酒精服务政策，寻求护理和预防工具的可用性，如在其他地方工作的转诊信息。这种理解对于葡萄酒商店至关重要，因为这是高风险（艾滋病毒和有害酒精使用）顾客定期聚会和社交的地方。在这项研究中，基于行为改变的人-环境理论，我们试图了解和修改的葡萄酒商店的环境，这将有助于顾客寻求照顾艾滋病毒/性病和有害的酒精使用。公共卫生相关性：这种干预措施具有很高的公共卫生意义。通过探索在高危酒精使用场所使用技术和服务器培训进行基于场地的干预的可行性，我们希望收集初步数据，以进一步了解超越个人的艾滋病毒预防机制。我们还建议与政府合作，实施第一个此类伙伴关系，干预印度金奈的酒精服务场所。

DESCRIPTION (provided by applicant): As we enter the third decade of HIV prevention, evidence suggests the important role of individual alcohol use in facilitating the risk of HIV and STD acquisition. With 2.5 million adults living with HIV, India, after Africa, has the highest burden of HIV infected persons. Alcohol use, particularly among men, is gaining increasing attention from HIV prevention programmers and policy makers here as a risk factor amenable to change. While the strength of and existence of the association between alcohol use and risky sex has been debated in the scholarly literature, what is clear is the need to address venues where alcohol is used as a locus for HIV prevention efforts. In India, wine shops - community- based alcohol outlets- hold potential for a venue-based intervention. 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 - 3% (over nine times higher than the national rate of 0.3%); high rates (>50% of participants) of unprotected sex and alcohol use before sex and high levels of harmful alcohol use measured by more than five drinks per sitting (65%). We also found that venue patrons have minimal access to care for either HIV or alcohol use. Individual factors such as information of harmful drinking patterns, positive attitudes and towards seeking help and perceived drinking norms that have been shown to motivate care seeking and promote responsible alcohol use are little understood in India. Further, venue-level factors such as trained service staff, supportive alcohol serving policies, availability of care seeking and prevention tools such as referral information that have worked elsewhere are yet unexplored in India. This understanding is critical to obtain in wine shops as this is where high risk (for HIV and harmful alcohol use) patrons meet regularly and socialize. In this study, based on person-environment theory of behavior change, we seek to understand and modify the environment of the wine shop that will help patrons seek care for HIV/STDs and harmful alcohol use. PUBLIC HEALTH RELEVANCE: This intervention has high public health significance. By exploring the feasibility of a venue- based intervention using technology and server training in high risk alcohol use outlets, we hope to gather preliminary data that will further our understanding of the mechanics of targeting HIV prevention beyond the individual. We also propose to collaborate with the government to implement the first of its kind partnership to intervene in alcohol service venues in Chennai, India.