Reducing sexual risk behavior among high-risk couples in Northern India.
BACKGROUND
With a population of 1.1 billion, India is considered to be a country in which effective prevention interventions could contain the development of a human immunodeficiency virus (HIV) epidemic. Heterosexual transmission accounts for 85 % of the extant HIV infections.


OBJECTIVE
This study sought to assess the feasibility of conducting a group, culturally tailored behavioral intervention and its impact on sexual barrier use, self-efficacy, knowledge, conflict resolution, and coping among high-risk heterosexual couples in Northern India.


METHODS
This pilot study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India from February 2008 to January 2009. Thirty sexually active high-risk couples were drawn from a convenience sample of PGIMER patients attending infectious disease and family planning clinics. Couples participated in 1 month of three weekly gender-concordant behavioral intervention groups and were individually administered assessments preintervention and post-intervention. The intervention was tailored to the Northern Indian context and addressed sexual barrier use, human immunodeficiency virus (HIV)/sexually transmitted infection transmission, and cognitive behavioral skill building focusing on sexual negotiation and communication.


RESULTS
The participants had a mean age of 32 years (men) and 29 years (women), and the majority had at least 10 years of education. At baseline, the majority reported inconsistent condom use (<100 % of the time; 64 % of women, 59 % of men). Post-intervention, nearly all participants reported consistent condom use (100 % of the time; 100 % of men, 97 % of women). Participants also reported decreased verbal aggression, increased self-efficacy, and increased HIV-related knowledge, and women increased their use of positive coping tactics.


CONCLUSIONS
The results highlight the potential to successfully utilize a group intervention to discuss sensitive issues such as sexual risk behavior among both men and women. Strategies to improve condom use and communication without increasing intimate partner violence in high-risk couples may be an important adjunct to preventing the development of a generalized epidemic in India.
Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA, djones@med.miami.edu.
Deborah
D
Jones
Rashmi
R
Bagga
Ritu
R
Nehra
Deepika
Sunil
S
Sethi
Kamini
K
Walia
Mahendra
M
Kumar
Olga
O
Villar-Loubet
Maria
M
Lopez
Stephen M
SM
Weiss
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003142:Communication; D017579:Domestic Violence / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D010865:Pilot Projects; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D020377:Self Efficacy; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D055815:Young Adult