We propose a participatory approach for conceptualizing and implementing research-based interventions that has as its primary aim the development of acceptable and sustainable change efforts. The Participatory Intervention Model (PIM), rooted in participatory action research, provides a mechanism for integrating theory, research, and practice and for promoting involvement of stakeholders in intervention efforts. We present evidence of PIM's capacity for promoting intervention acceptability, drawing on our research experiences in international sexual-risk prevention work. We conclude with a discussion of PIM's potential for bridging the gap between research and practice, addressing cultural diversity, fostering partnerships, promoting disciplined reflective practice, and integrating the multiple roles of the school psychologist.In recent years, researchers and practitioners in the field of school psychology have recognized the need for a broad conception of intervention development and evaluation that addresses intervention acceptability and integrity, in addition to efficacy

Ethnographic methods complement standard treatment or control group studies by providing contextual and culturally sensitive information to administrators and service providers in AIDS prevention programs.

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This paper examines the relationship of migration and mobility of husband and wife to sexual risk behaviors among married men living in economically marginal communities in Mumbai, India. Non-migrant men reported significantly more often than the migrant men that they had one or more sex partners other than their wives in the last year. Further, men with occupational mobility reported significantly more often than the men who were not mobile that they had one or more non-spousal sexual partners in the last 1 year. Married men living in Mumbai with wives residing in their area of origin and who reported occupational mobility had the highest sexual risk behaviors, controlling for socio-demographic characteristics and migration. Interventions aimed at prevention of HIV among men require special focus on both migrant and non-migrant men with greater occupational mobility, with particular emphasis on migrant men whose wives have remained in their pre-migration home areas.

Background: The rollout of antiviral therapy in Low and Middle Income Countries (LMICs) has reduced HIV transmission rates at the potential risk of resistant HIV transmission. We sought to predict the risk of wild type and antiviral resistance transmissions in these settings. Methods: A predictive model utilizing viral load, ART adherence, genital ulcer disease, condom use, and sexual event histories was developed to predict risks of HIV transmission to wives of 233 HIV+ men in 4 antiretroviral treatment centers in Maharashtra, India. Results: ARV Therapy predicted a 5.71-fold reduction in transmissions compared to a model of using condoms alone, with 79.9%, of remaining transmissions resulting in primary ART-resistance. Conclusions: ART programs reduce transmission of HIV to susceptible partners at a substantial increased risk for transmission of resistant virus. Enhanced vigilance in monitoring adherence, use of barrier protections, and viral load may reduce risks of resistant HIV transmissions in LMIC settings.

While there has been a trend toward greater disciplinary collaboration over the last several decades, the emergence of the HIV pandemic has required that disciplines work more closely and creatively to generate the multiple and innovative approaches necessary to meet the demands for effective prevention and treatment. This paper describes the nature of collaborative relationships among U.S. and Indian anthropologists, psychologists, demographers, epidemiologists, physicians and representatives of other fields and sectors in conducting a large scale, multi-year HIV/STD prevention project directed toward married men in urban poor communities in Mumbai (Bombay), India. The project has challenged members of the participating disciplines to develop a transdisciplinary conceptual model, to test the model with community-based formative research and to utilize the results in the development and implementation of a multi-level (community, provider and patient) intervention. The paper describes the interaction among disciplines and international sectors in the conceptualization, methodology and community-based action components of the project. In addition, it examines both the inhibiting and facilitating factors that are a part of the collaborative process. The paper concludes with implications for future transdisciplinary partnerships.

The objectives of this paper are to (1) understand the nature of men's extramarital sexuality in three low income communities in Mumbai, India; (2) explore the associations between marital relationships and extramarital sex; and (3) assess the implications of the research results for intervention. Results are based on survey data collected from 2,408 randomly selected men from the three study communities and a matched subset of 260 randomly selected men and their wives who responded to a female version of the men's survey. These surveys produced a unique data set, which allows sociodemographic, attitudinal and behavioral variables from husband and wife and variables that are the product of husband and wife interaction to be utilized to predict men's extramarital sex through multiple sequential logistic regression analysis. Results indicate that men's extramarital sex is significantly associated with husband's and wife's age, wife's perception of domestic violence, husband's education and place of birth, husband's alcohol use, wife's willingness to engage in marital sex, and types of marital sexual acts. These results confirm the need to move from the individual to the couple as the unit of research and the need for intervention to reduce the risk of HIV/STI transmission within marriage both in India and internationally.

Background and objectives A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis. Design, setting, participants, & measurements We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy. Results From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease. Conclusions A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.