Protecting Women from Economic shocks to fight HIV in Africa (POWER)

艾滋病毒/艾滋病是全球死亡的主要原因之一，也是15-44岁妇女死亡的主要原因。15至24岁的非洲妇女感染艾滋病毒的可能性是同龄男性的两倍。喀麦隆是全球艾滋病毒感染性别差异最大的国家之一，少女感染艾滋病毒的可能性是同龄男孩的五倍。越来越多的研究表明，在交易性行为和商业性行为中所承担的风险——以及生物易感性——是造成艾滋病毒/艾滋病的性别不平等的原因。然而，人们对促使非洲妇女从事这些行为的危险性行为的主要原因有肤浅的了解。最近的研究表明，妇女采取危险的性行为主要是为了应对负面的收入冲击（例如农业和气候冲击、家庭成员的疾病或死亡），并表明经济冲击是非洲艾滋病毒难题的重要组成部分。如果妇女采取危险的性行为来应对负收入冲击，那么为妇女提供正式的风险应对策略可能是预防艾滋病毒的一种非常有希望的方法。然而，仍然存在重要的知识空白，主要是因为之前的研究没有专门设计来回答这个研究问题。这项研究的目标是填补这些知识空白，以便为设计新的公共卫生干预措施提供信息，以解决性传播感染（STIs）和艾滋病毒。具体而言，本研究旨在(1)估计影响家庭的经济冲击对年轻女性性行为、性传播感染和艾滋病毒感染的影响；(2)确定经济冲击影响性传播感染和艾滋病毒的渠道；(3)估计健康保险作为一项保护妇女免受经济冲击以预防性传播感染和艾滋病毒的战略的有效性；(4)衡量保护妇女免受经济冲击以在一般人群中预防艾滋病毒的干预措施的成本效益。这项拟议的研究将跟踪喀麦隆一组新的妇女。这项研究将招募1500名未婚少女和从事交易性行为或商业性行为的年轻女性。在一年的时间里，这项研究将收集三份生物行为和社会经济调查，以及每周的性日记（n=78,000）。一项随机对照试验将嵌入到队列研究中，并将为分配到治疗组的妇女提供正式的风险应对策略（家庭健康保险）。这项研究对于解决我们这个时代的一项重大公共卫生挑战是迫切需要的，并且具有对制定艾滋病毒/艾滋病研究议程产生长期持久影响的强大潜力。

HIV/AIDS is one of the leading cause of mortality globally and the leading cause among women aged 15-44 years. African women aged 15-24 are twice more likely to be infected with HIV than their male counterparts. In Cameroon, one of the countries with the highest gender disparity in HIV globally, adolescent girls are five times more likely to be infected with HIV than boys of the same age. There is a growing number of studies showing that risks taken during transactional sex and commercial sex -in addition to biological susceptibility- are responsible for gender inequalities in HIV/AIDS. However, there is superficial understanding of the main causes driving risky sexual behaviours of women who engage in those practises in Africa. Recent studies have shown that women mainly adopt risky sexual behaviours in order to cope with negative income shocks (e.g. agricultural and climatic shocks, illness or death of family members) and suggest that economic shocks are a substantial piece of the HIV puzzle in Africa. If women adopt risky sexual behaviours to cope with negative income shocks, hence providing women formal risk-coping strategies could be a very promising approach to prevent HIV. However, there are still important gaps in knowledge, mainly because no previous study has been designed to specifically answer this research question. The goal of this research is to fill these gaps in knowledge in order to inform the design of novel public health interventions to tackle sexually transmitted infections (STIs) and HIV. Specifically, the study aims (1) to estimate the effect of economic shocks affecting households on sexual behaviours and STI and HIV acquisition of young women, (2) to identify the channels through which economic shocks affect STIs and HIV, (3) to estimate the effectiveness of health insurance as a strategy to protect women from economic shocks in order to prevent STI and HIV and (4) to measure the cost-effectiveness of an intervention that protects women from economic shocks to prevent HIV in the general population. The proposed study will follow a new cohort of women in Cameroon. The study will recruit 1,500 unmarried adolescent girls and young women engaging in transactional sex or commercial sex. Over a 1-year period, the study will collect three biobehavioural and socioeconomic surveys as well as weekly sexual diaries (n=78,000). A randomised controlled trial will be embedded to the cohort study and will provide women allocated to the treatment group with a formal risk-coping strategy (a family health insurance). This research is of immediate necessity to address a vital public health challenge of our time and has the strong potential to have a long lasting impact on shaping the research agenda on HIV/AIDS.