• Test the proposition that traditional,    culturally-based male concerns predict higher rates of HIV/STD.
• Determine the degree to which an intervention using culturally-based sexual health concerns can attract men into HIV/STD education, sexual-risk reduction and early identification of HIV/STD.
• Further develop, test and evaluate a culturally-based therapeutic approach to male sexual health problems.
• Assess the relative efficacy of developing the approach with allopathic versus non-allopathic doctors serving men with sexual health problems.
• Assess the impact of the approach in decreasing HIV/STDs and traditional sexual health concerns and increasing knowledge of transmission and treatment of HIV/STDs in the general community.

Project Details
Universal anxieties and sexual health concerns among men (e.g., premature ejaculation, impotence, infertility) become more problematic in India as sex is often associated with matters of pollution and purity. Past research indicates that Indian men are more concerned about performance issues related to semen loss than they are about sexually transmitted infections. The study's three components - formative research, intervention and evaluation - are used to further understand the dynamic between sexual health concerns, cultural beliefs and HIV/STD transmission.

Formative research includes in-depth interviews with men and doctors in the three communities to understand the sexual health concerns of men and to develop the intervention approach. Project staff will conduct educational sessions throughout the three communities (in collaboration with existing community-based organizations) about HIV/STD risk, using the session to advertise the study. Collaborating organizations will become a referral network for the project's intervention component.

The intervention will begin with a survey of all three communities as a pre-post evaluation instrument. All three communities will receive the educational sessions and community-wide survey, while only two will receive the intervention (one aimed at allopathic and the other at traditional doctors); the third community will serve as a control site. Project staff will train doctors (approximately 50 in each community) in the Narrative Intervention Model (NIM). NIM uses personal narratives (stories) to facilitate the assessment-intervention process, incorporating the medical, social-cultural and psychological components of sexual health problems faced by men. Participating doctors will also provide STD testing and referral as needed to study participants.

The intervention will be evaluated for acceptability, integrity and outcome. Data will be gathered through clinic records, pre-post interviews of patients and doctors, observations and training support with doctors, a monitoring protocol, and a repeat of the community-wide survey to assess the impact of the intervention on the community at large. The study hypothesizes that the intervention implemented through traditional doctors will be more successful than through allopathic doctors, as traditional doctors already address cultural beliefs associated with many of the health concerns presented by men.