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增加艾滋病毒和性病感染风险方面的重要作用。印度有250万成年人感染艾滋病毒，仅次于非洲，是艾滋病毒感染者负担最重的国家。酒精的使用，特别是在男性中，正日益受到艾滋病毒预防规划人员和政策制定者的关注，认为这是一个可以改变的风险因素。虽然在学术文献中对酒精使用与危险性行为之间的联系的强度和存在性一直存在争议，但明确的是需要解决将酒精用作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——具有以场所为基础的干预的潜力。我们的团队——位于印度钦奈的约翰霍普金斯大学和YRG艾滋病研究中心（YRG CARE）——自2000年以来一直在钦奈的葡萄酒商店开展工作，实施以个人为中心的意见领袖主导的社会规范改变艾滋病预防干预（NIMH U10MH 681543-01）。在这项研究中，我们发现顾客的艾滋病毒负担高- 3%（比全国0.3%的比率高出9倍以上）；无保护的性行为和性行为前饮酒的比例高（50%的参与者），以及每次饮酒超过5杯的有害饮酒水平高（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。个人因素，如有害饮酒模式的信息、积极的态度和寻求帮助的态度以及公认的饮酒规范，已被证明可以激励求医和促进负责任的饮酒，在印度却知之甚少。此外，场所层面的因素，如训练有素的服务人员、支持性的酒精服务政策、求诊和预防工具（如转诊信息）的可得性，在其他地方已经起作用，在印度尚未探索。在葡萄酒商店获得这种理解是至关重要的，因为这是高风险（艾滋病毒和有害酒精使用）顾客经常见面和社交的地方。在这项研究中，基于行为改变的人-环境理论，我们试图理解和修改葡萄酒商店的环境，以帮助顾客寻求艾滋病毒/性病和有害酒精使用的护理。公共卫生相关性：该干预措施具有很高的公共卫生意义。通过探索在高风险酒精使用场所使用技术和服务人员培训的场地干预的可行性，我们希望收集初步数据，以进一步了解针对个人以外的艾滋病毒预防机制。我们还建议与政府合作，在印度金奈实施首个此类伙伴关系，干预酒精服务场所。

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.