Ethnographic mapping of alcohol use and risk behaviors in Delhi

Exploring aflatoxin contamination and household-level exposure risk in diverse Indian food systems

The present study sought to identify household risk factors associated with aflatoxin contamination within and across diverse Indian food systems and to evaluate their utility in risk modeling. Samples (n = 595) of cereals, pulses, and oil seeds were collected from 160 households across four diverse districts of India and analyzed for aflatoxin B1 using enzyme-linked immunosorbent assay (ELISA). Demographic information, food and cropping systems, food management behaviors, and storage environments were profiled for each household. An aflatoxin detection risk index was developed based on household-level features and validated using a repeated 5-fold cross-validation approach. Across districts, between 30–80% of households yielded at least one contaminated sample. Aflatoxin B1 detection rates and mean contamination levels were highest in groundnut and maize, respectively, and lower in other crops. Landholding had a positive univariate effect on household aflatoxin detection, while storage conditions, product source, and the number of protective behaviors used by households did not show significant effects. Presence of groundnut, post-harvest grain washing, use of sack-based storage systems, and cultivation status (farming or non-farming) were identified as the most contributive variables in stepwise logistic regression and were used to generate a household-level risk index. The index had moderate classification accuracy (68% sensitivity and 62% specificity) and significantly correlated with village-wise aflatoxin detection rates. Spatial analysis revealed utility of the index for identifying at-risk localities and households. This study identified several key features associated with aflatoxin contamination in Indian food systems and demonstrated that household characteristics are substantially predictive of aflatoxin risk.

The lived experience of violence and health-related risks among street sex workers in Uyo, Nigeria

This study examined the lived experience of violence and health-related risks among street sex workers in Uyo, Nigeria. Data were collected through in-depth, individual interviews with 27 female sex workers recruited through venue-based snowball sampling. Thematic coding and analysis were undertaken on interview transcripts. Findings show that sex workers experienced physical, emotional, sexual and economic violence linked to the criminalisation and stigmatisation of sex work. Violence, perpetrated by clients, police, sexual partners and co-sex workers, was used to coerce unprotected sex and free and unacceptable sexual services; to extort money; to prevent client-snatching; and as moral punishment. Violence harms sex workers' health, undermines condom negotiation and increases STI/HIV risk. Sex workers displayed agency by adopting safety strategies, including screening clients, collaboration, bribing the police for protection and self-defence. Agency was constrained by criminalisation and lack of legal protection. Within this context, the decriminalisation of sex work, the regulation of sex work premises, community mobilisation, economic empowerment and health services are relevant measures for addressing violence and improving sex workers' health.

Mind the gap: implementation challenges break the link between HIV/AIDS research and practice

Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic.

DEFINING THE "COMMUNITY" FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS

Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.

Alcohol consumption in relation to work environment and key sociodemographic characteristics among female sex workers in China

The study explores the variation in pattern of alcohol use and related risk behaviors by types of sex work environments and sociodemographic characteristics among female sex workers (FSWs) in China. Data were collected from 1,022 FSWs in Guangxi, China, through a self-administered questionnaire. Chi-square and analysis of variance (ANOVA) were used to assess the variations. Results showed that younger FSWs were more susceptible than older FSWs to nearly all the risk drinking behaviors. FSWs of non-Han ethnicity as compared with those of Han ethnicity were more at risk of drinking large amounts of alcohol and having sex under the influence of alcohol. FSWs in entertainment establishments were most likely to have all kinds of risk drinking behaviors. Street-based FSWs were least likely to drink alcohol but more or equally likely to engage in alcohol-related sexual risk behaviors. The study highlights a need to develop tailored alcohol risk reduction intervention that takes into consideration these differences.

A methodology for building culture and gender norms into intervention: an example from Mumbai, India

This paper responds to the call for culturally-relevant intervention research by introducing a methodology for identifying community norms and resources in order to more effectively implement sustainable interventions strategies. Results of an analysis of community norms, specifically attitudes toward gender equity, are presented from an HIV/STI research and intervention project in a low-income community in Mumbai, India (2008-2012). Community gender norms were explored because of their relevance to sexual risk in settings characterized by high levels of gender inequity. This paper recommends approaches that interventionists and social scientists can take to incorporate cultural insights into formative assessments and project implementation These approaches include how to (1) examine modal beliefs and norms and any patterned variation within the community; (2) identify and assess variation in cultural beliefs and norms among community members (including leaders, social workers, members of civil society and the religious sector); and (3) identify differential needs among sectors of the community and key types of individuals best suited to help formulate and disseminate culturally-relevant intervention messages. Using a multi-method approach that includes the progressive translation of qualitative interviews into a quantitative survey of cultural norms, along with an analysis of community consensus, we outline a means for measuring variation in cultural expectations and beliefs about gender relations in an urban community in Mumbai. Results illustrate how intervention strategies and implementation can benefit from an organic (versus a priori and/or stereotypical) approach to cultural characteristics and analysis of community resources and vulnerabilities.

Community-level HIV/STI interventions and their impact on alcohol use in urban poor populations in India

This paper describes an Indo-US, research and intervention project for HIV/STI prevention and sexual risk reduction in urban poor communities in Mumbai, India in which formative research established the importance of reduction in alcohol use as one of the central features of the intervention. As a part of formative research, in-depth interviews with married women and men indicated that alcohol had a direct negative effect on marital relationships, violence, household economics and men's involvement in extramarital sex. The project utilized diverse community intervention mechanisms over the course of a three year intervention effort. Comparison of pre-post intervention, cross-sectional samples showed a significant drop in overall use of alcohol in the study communities. Analysis of a longitudinal panel sample identified sub-groups of married men based on their demographic, behavioral and attitudinal characteristics at baseline who stopped drinking during the intervention period. Results also demonstrated that a reduction in men's alcohol use during the intervention period was associated with a reduction in sexual risk behavior and related variables.