India's at-risk populations
Yale's Center for Interdisciplinary Research on AIDS (CIRA) has received a $2.1 million grant from the Bill & Melinda Gates Foundation to support HIV prevention research among high-risk populations in India.
The three-year grant will be used to conduct research on implementing structural interventions among high-risk groups in the four southern states of India with the highest HIV prevalence: Andhra Pradesh, Karnataka, Tamil Nadu and Maharashtra.
Structural interventions promote public health by altering the context within which individuals engage in health behaviors or make health-related decisions. In HIV prevention, such interventions seek to alter social, economic, political and normative factors that make up the risk environments for HIV infection where individuals live and work.
"We are pleased to be a partner in efforts to curtail the spread of HIV infection in one of the largest countries in the world," said Dr. Michael H. Merson, dean and the Anna M.R. Lauder Professor of Public Health and an investigator on the project.
The Yale team will collaborate in this project with CARE, an international field relief and development organization, through its India Country Office. The team will also work with other partners receiving support as part of the Bill & Melinda Gates Foundation's Avahan initiative to conduct structural analyses of HIV risk and assess structural interventions for HIV prevention.
CARE -- led by S. Jana, assistant country director for health, HIV and development -- is also a grantee under the Avahan initiative of the Bill & Melinda Gates Foundation. It is one of a number of non-governmental organizations working to implement successful models of community-led structural preventions for addressing HIV risk among populations hit hardest by the epidemic in India, particularly among sex workers and their clients, who include truckers and injecting drug users.
The Yale team will seek to assess whether CARE's interventions, aimed at enhancing empowerment and decreasing vulnerability, increase healthier behavior among sex workers and their clients. The goals of the interventions include increased condom use, reduced prevalence of sexually transmitted infections, increased self-esteem and empowerment on the part of sex workers, and improved attitudes, practices and policies toward sex workers on the part of various power brokers such as pimps, brothel operators, bar owners and police.
"Using structural interventions, we can have a substantial impact on HIV transmission among many people simultaneously and often on other health risks at the same time," says principal investigator Kim M. Blankenship, CIRA associate director and associate research scientist in the Department of Epidemiology and Public Health (EPH) in the School of Medicine.
India's National AIDS Control Organization estimates that at the end of 2003 there were 5.1 million people living with HIV/AIDS in the country. It has also estimated that there were 520,000 new HIV infections in 2003. As in many other countries, the poor and socially marginalized in India bear the majority of the HIV burden.
"While it is clear that some of the most vulnerable populations have a relatively high degree of knowledge on HIV/AIDS issues, unsafe sex practices persist," says Blankenship. "This suggests that their vulnerability to infection rests less in their lack of knowledge about HIV/AIDS than in the structural barriers that restrict their ability to act on this knowledge. It is these barriers, and other structural factors, that need to be addressed to reduce risk and transmission. Structural interventions provide a means for doing this."
Other investigators on the project include: Trace Kershaw, assistant professor of epidemiology; Linda Niccolai, assistant professor of epidemiology and public health; Jean J. Schensul, executive director of The Institute for Community Research in Hartford; Scott Burris, the James E. Beasley Professor of Law at Temple University Beasley School of Law; and Douglas Heackathorn, professor of sociology at Cornell University.
CIRA was established in 1997 and is currently funded through a core grant from the National Institute of Mental Health.
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