Multilevel Perspectives on Community Intervention: An Example from an Indo-US HIV Prevention Project in Mumbai, India

  • Stephen L. Schensul
  • Niranjan Saggurti
  • Rajendra Singh
  • Ravi K. Verma
  • Bonnie K. Nastasi
  • Papiya Guha Mazumder
Original paper

Abstract

This paper explores the meaning and applicability of multilevel interventions and the role of ethnography in identifying intervention opportunities and accounting for research design limitations. It utilizes as a case example the data and experiences from a 6-year, NIMH-funded, intervention to prevent HIV/STI among married men in urban poor communities in Mumbai, India. The experiences generated by this project illustrate the need for multilevel interventions to include: (1) ethnographically driven formative research to delineate appropriate levels, stakeholders and collaborators; (2) identification of ways to link interventions to the local culture and community context; (3) the development of a model of intervention that is sufficiently flexible to be consistently applied to different intervention levels using comparable culturally congruent concepts and approaches; (4) mechanisms to involve community residents, community based organizations and community-based institutions; and (5) approaches to data collection that can evaluate the impact of the project on multiple intersecting levels.

Keywords

HIV/STI prevention India Multi-level Urban poor Culturally-based 

References

  1. Azjen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  2. Basu, S. (2004). Aids, empire and public health behaviorism. International Journal of Health Srevices, 34(1), 155–167.CrossRefGoogle Scholar
  3. Becker, S., & Robinson, J. C. (1998). Special communication—reproductive health care: Services oriented to couples. International Journal of Gynecology and Obstetrics, 61, 275–281.PubMedCrossRefGoogle Scholar
  4. Blankenship, K. M., Friedman, S. R., Dworkin, S., & Mantell, J. E. (2006). Structure interventions: Concepts, challenges and opportunities for research. Journal of Urban Health, 83(1), 59–72.PubMedCrossRefGoogle Scholar
  5. Coates, T. J., Richter, L., & Caceres, C. (2008). Behavioral Strategies to reduce HIV transmission: How to make them work better. The Lancet, 372, 669–684.CrossRefGoogle Scholar
  6. Cruiz, P. C. (2007). Mumbai’s housing is the priciest in the developing world. Global property guide. Retrieved Sep 27, 2007, from http://www.globalpropertyguide.com/articleread.php?article_id=91&cid.
  7. DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2007). A review of STD/HIV prevention interventions for adolscents: Sustaning effects using an ecological approach. Journal of Pediatric Psychology, 32(8), 888–907.PubMedCrossRefGoogle Scholar
  8. DiClemente, R. J., Salazar, L. F., Crosby, R. A., & Rosental, S. L. (2005). Prevention and control of sexually transmitted inforctions among adolescents: The importance of socio-ecological perceptibe-a commentary. American Journal of Public Health, 119, 825–836.CrossRefGoogle Scholar
  9. Fisher, W. A., & Fisher, J. D. (1993). A general social psychological model for changing AIDS risk behavior. In J. B. Pryor & G. D. Reeder (Eds.), The social psychology of HIV infection (pp. 127–153). Hillsdale, NJ: Erlbaum.Google Scholar
  10. Fuller, C. M., Galea, S., Ceceres, W., Blaney, S., Sisco, S., & Blahov, D. (2007). Multilevel community-based intervention to increase access to sterile syringes among injection drug users through pharmacy sales in New York city. American Journal of Public Health, 97(1), 1–124.Google Scholar
  11. Heise, L., & Elias, C. (1995). Transforming AIDS prevention to meet women’s needs. Social Science and Medicine, 40(7), 931–943.PubMedCrossRefGoogle Scholar
  12. Kelly, J. A., St. Lawrence, J. S., Stevenson, L. Y., Hauth, A. C., Kalichman, S. C., Diaz, Y. E., et al. (1992). Community AIDS/HIV risk reduction: The effects of endorsements by popular people in three cities. American Journal of Public Health, 82(11), 1483–1489.PubMedCrossRefGoogle Scholar
  13. Kulhara, P., & Avasthi, A. (1995). Sexual dysfunction on the Indian subcontinent. International Review of Psychiatry, 7(2), 231–240.CrossRefGoogle Scholar
  14. Mann, J. M., Tarantola, D., & Netter, T. W. (1992). AIDS in the world: The global AIDS policy coalition. Cambridge, MA: Harvard University Press.Google Scholar
  15. Mosely, A. (2004). Does HIV or poverty cause AIDS? Biomedical and Epidemiological Perspectives. Theoretical Medicine, 25, 399–421.CrossRefGoogle Scholar
  16. Nijman, J. (2006). Mumbai’s mysterious middle class. International Journal of Urban and Regional Research, 30(4), 758–775.CrossRefGoogle Scholar
  17. Pelto P. J., Joshi A.,& Verma R. (1999). The development of Indian male sexuality. Population Council: South and Southeast Asian Regional Office, pp. 54.Google Scholar
  18. Rhodes, T., Singer, M., Bourgois, P., Friedman, S. R., & Strathdee, S. A. (2005). The social structural production of HIV risk among injecting drug users. Social Sciences and Medicine, 61, 1026–1044.CrossRefGoogle Scholar
  19. Risbud, N. (2003). The case of Mumbai, India. In understanding slums: Case studies for the global report on human settlements. London: Earthscan.Google Scholar
  20. RISHTA. (2007). Addressing Gupt Rog: Narrative prevention counseling for STI/HIV prevention—A guide to AYUSH and allopthic practitioners. New Delhi, India: Population Council.Google Scholar
  21. Schensul, S. L., Hawkes, S., Saggurti, N., Verma, R. K., Narvekar, S. S., Nastasi, B. K., et al. (2007). Sexually transmitted infections in men in Mumbai slum communities: The relationship of prevalence to risk behavior. Sexually Transmitted Diseases, 34(7), 444–450.PubMedGoogle Scholar
  22. Schensul, S. L., Mekki-Berrada, A., Nastasi, B. K., & Saggurti, N. (2006a). Healing traditions and men’s sexual health in Mumbai, India: The realities of practiced medicine in urban poor communities. Social Science and Medicine, 62(11), 2774–2785.PubMedCrossRefGoogle Scholar
  23. Schensul, S. L., Mekki-Berrada, A., Nastasi, B. K., Singh, R., Burleson, J. A., & Bojko, M. (2006b). Men's extramarital sex, marital relationships and sexual risk in urban poor communities in India. Journal of Urban Health, 83(4), 614–624CrossRefGoogle Scholar
  24. Schensul, S. L., Verma, R. K., & Nastasi, B. K. (2004). Responding to men’s sexual concerns: Research and intervention in slum communities in Mumbai, India. International Journal of Men’s Health, 3(3), 197–220.CrossRefGoogle Scholar
  25. Singer, M. C., Erickson, P. I., Badiane, L., Ortiz, D., Abraham, T., & Nickolaysen, A. M. (2006). Syndemics, sex and the city: Understanding sexually transmitted diseases in social and cultural context. Social Science and Medicine, 63(8), 2010–2021.PubMedCrossRefGoogle Scholar
  26. SPARC-Society for the promotion of area resource centers (2003) Regulatory guidelines for urban upgradation: The case of Mumbai. http://practicalaction.org/docs/shelter/rguu_sparc_changing_the_rules.pdf Accessed on: 8/07/08.
  27. UNAIDS. (2004). India: Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections. Geneva: UNAIDS/WHO.Google Scholar
  28. UNAIDS. (2007). AIDS epidemic update, December 2007. Geneva: UNAIDS/WHO.Google Scholar
  29. Verma, R. K., Rangaiyan, G., Singh, R., Sharma, S., & Pelto, P. J. (2001). A study of male sexual health problems in a Mumbai slum population. Culture, Health and Sexuality, 3(3), 339–352.CrossRefGoogle Scholar
  30. Verma, R. K., & Schensul, S. L. (2004). Male Sexual Health Problems in Mumbai: Cultural Constructs that Present Opportunities for HIV/AIDS Risk Reduction. In R. K. Verma, P. J. Pelto, S. L. Schensul, & A. Joshi (Eds.), Sexuality in the time of aids: Contemporary perspectives from communities in India (pp. 243–261). New Delhi: Sage Publications.Google Scholar
  31. WHO. (2003). Facts about HIV/AIDS: Southeast Asia region-Table 2: Estimated HIV prevalence and ART needs in SEAR. Retrieved Dec 2004, from http://w3.whosea.org/hivaids/factsheet.htm

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Stephen L. Schensul
    • 1
  • Niranjan Saggurti
    • 2
  • Rajendra Singh
    • 3
  • Ravi K. Verma
    • 4
  • Bonnie K. Nastasi
    • 5
  • Papiya Guha Mazumder
    • 6
  1. 1.Department of Community Medicine & Health CareUniversity of Connecticut School of MedicineFarmingtonUSA
  2. 2.Population CouncilNew DelhiIndia
  3. 3.International Center for Research on WomenMumbaiIndia
  4. 4.International Center for Research on WomenNew DelhiIndia
  5. 5.Department of PsychologyTulane UniversityNew OrleansUSA
  6. 6.International Institute for Population SciencesMumbaiIndia

Personalised recommendations