Project Description

Alcohol, Sexual Risk and HIV Prevention in Mumbai, India

This three-year study investigated how alcohol may contribute to  risky sexual activities that lead to HIV transmission among married and unmarried men and their sexual partners in three low income slums in the Mumbai metropolitan area. As data were collected, stakeholders from these communities were partnering with researchers to develop culturally specific interventions that simultaneously address HIV transmission rates on the individual, family and community levels. In particular, researchers explored the role that migration (from rural areas to Mumbai) played in exposing networks of men to alcohol, drugs and unprotected sex and the role of long term residence in Mumbai as a risk factor. Unique features of the study were its attention to social scripting of drinking and sex and the role of social geography in contributing to drinking and associated sexual behaviors and social risk. The study also strengthened the capacity of Mumbai’s International Institute for Population Sciences to integrate qualitative and quantitative research.

Additional Information:

Project staff:

ICR

Jean J. Schensul, Ph.D.
Principal Investigator

Marlene Berg, MUP.
Associate Director for Training

Ellen Cromley, Ph.D.
Medical Geographer

IIPS

Kamla Gupta, Ph.D.
Co-Principal Investigator

S.K. Singh, Ph.D.
Co-Principal Investigator

Subrata Lahiri, Ph.D.
Co-Principal Investigator

Madhusudana Battala
Senior Research Officer

Ruchi Sogarwal, Ph.D.
Senior Research Officer

Prabhat Kumar, M.A.
Research Officer

Chandrashekhar Joshi
Research Officer

Ajeet Kumar
Community Worker

Deepak S. Supe
Community Worker

T.S. Badve
Assistant

UCHC

Stephen Schensul, Ph.D.
Co-PI

Tom Babor, Ph.D.
Consultant

HIV rates are increasing dramatically in India. Estimates suggest that over 5 million adults are infected, and AIDS is expected to emerge as the most significant cause of adult mortality in the next decade. The state of Maharashtra has among the highest HIV rates in the country, concentrated in Mumbai and Pune. Migrant populations moving in and out of Mumbai increase the potential for disease transmission into the general population, while also changing the social context of drinking in Mumbai. Alcohol use is widely associated with sexual risks, STDs, and social harm including early sexual debut, multiple partners, inconsistent condom use, lack of protection during intercourse, unwanted pregnancies, and sexual violence. As HIV/AIDS infection rates increase particularly in Mumbai, more research is needed to analyze how alcohol may influence the spread of the disease.

Through a training grant from the World AIDS Foundation, ICR began collaborating with IIPS to increase IIPS’s qualitative research capacity for studies of substance use and reproductive health. A pilot study, part of the training grant, identified the need for further study of the social epidemiology of alcohol use, and its role in promoting risky sexual behavior that can lead to HIV transmission. ICR also conducted RISHTA: Male Sexual Health in India, which was an intervention study that worked to engage males in reproductive health education, sexual risk and early HIV/STD treatment in three urban communities in Mumbai, India. A corresponding supplement works with married women who are at increased HIV and sexual violence risk due to their husbands’ alcohol and sexual related risk. Alcohol, Sexual Risk and HIV Prevention in Mumbai, India focuses on communities characterized by long term and recent migration from rural areas of the western, southern and northern states, and the factors that promote male social drinking and link alcohol and sexuality in the media, among male drinkers, and between male drinkers and their sexual
partners. The study has broad applications for India, since alcohol is being produced and widely marketed and serves a number of social, psychological and physiological functions across classes.

Researchers collected qualitative data from ethnographic interviews and observations in several slum communities in the Greater Mumbai area where approximately 120,000 people reside. Researchers also used GIS mapping to identify critical sites where alcohol consumption and risky sex take place.  To examine the circumstances under which alcohol may contribute to unprotected sex, researchers conducted approximately 75 in-depth interviews with male drinkers, bar girls, young women, commercial sex workers, and others who may be familiar with the sexual services industry in the area as well as the wives of drinkers. Subsequently, the project recruited and surveyed a representative sample of 800 drinking men who were sexually active, and were between the ages of 18-40. The project also surveyed approximately 100 women with husbands who drink to investigate the consequences of male drinking on their lives and their households. The formative research informed the development of culturally specific, multi-pronged interventions designed to reduce alcohol use and risky sexual behavior.
Poster presentation (pdf)