Economic Opportunity for Zimbabwean Adolescent Orphans

描述（由申请人提供）：本项目的总体目标是通过随机对照设计，确定旨在加强对性行为的控制的创新经济和生活技能干预是否可以防止津巴布韦16-19岁的失学女孤儿无保护性行为的不良后果。我们最近完成了一项研究，该研究评估了这一项目的可行性，并将评估该干预措施对性传播感染（包括艾滋病毒）以及意外怀孕的影响。干预措施包括一个综合小额信贷计划，包括创业培训、贷款提供、实用商业教育、指导和同伴支持小组。这将与以前测试过的生活技能教育课程相结合，该课程通过使用角色扮演、绘画练习和其他技巧来提供艾滋病毒/生殖健康教育，以帮助参与者谈判其性关系的条款。为了评估这种综合干预措施在生活技能之外的效果，对照组将接受生活技能教育课程、“安慰剂”健康和营养培训，以及持续的同伴支持小组。虽然这种结合经济和生活技能的方案在改善青春期女孤儿的生殖健康方面有很大的潜力，但迄今为止还没有研究评估这种干预措施对这一群体或任何其他风险群体的性危险行为、性传播感染/艾滋病毒或怀孕结果的影响。我们的干预是由一个因果模型指导的，在这个模型中，提供经济选择和机会（通过小额信贷干预）和性谈判技巧（通过生活技能干预）是增强对性互动控制的驱动力，从而减少高风险行为和不利的生物后果。该项目的具体目标是：1)评估小额信贷和生活技能教育相结合的干预措施在减少我们的主要结果：2型单纯疱疹病毒（HSV2）和意外怀孕发生率方面的有效性；2)评估小额信贷和生活技能教育相结合的干预措施在降低高风险行为（如无保护的性行为、性伴侣数量、交易性行为、过早性行为、性胁迫和性暴力）方面的有效性；3)考察经济机会的增加和性谈判技巧的提高在增强参与者对性互动控制中的中介作用；4)评估与参与相关的特征，即参与者的依从性、满意度和对干预的理解是否介导了观察到的效果。

DESCRIPTION (provided by applicant): The overall aim of this project is to determine, using a randomized controlled design, whether an innovative economic and life-skills intervention designed to increase control over sexual interactions prevents the adverse consequences of unprotected sex among out-of-school female orphans aged 16-19 in Zimbabwe. The intervention, which builds on our recently completed study that assessed the feasibility of such a program, will be evaluated for its effect on the acquisition of sexually transmitted infections, including HIV, as well as unintended pregnancy. The intervention consists of an integrated micro-credit program, including entrepreneurial training, loan provision, practical business education, mentorship, and peer support groups. This will be combined with a previously-tested fife-skills education curriculum that delivers HIV/reproductive health education through the use of role plays, drawing exercises, and other techniques, to help participants negotiate the terms of their sexual relationships. In order to assess the effects of this combined intervention over and above life-skills alone, the control group will receive the fife-skills education curriculum, a "placebo" health and nutrition training, and on-going peer support groups. Although there is great potential for such combined economic and life-skills programs to improve the reproductive health of female adolescent orphans, no research to date has assessed the effect of such interventions on sexual risk behaviors, STI/HIV or pregnancy outcomes in this or any other at-risk group. Our intervention is guided by a causal model in which the provision of economic alternatives and opportunities (through the micro-credit intervention) and sexual negotiation skills (through the life-skills intervention) are the driving forces in increasing control over sexual interactions, and thus reducing high-risk behaviors and adverse biological outcomes. The specific aims of this project are: 1) To assess the effectiveness of a combined micro-credit and life-skills education intervention in reducing the incidence of our primary outcomes: Herpes simplex virus type 2 (HSV2) and unintended pregnancy; 2) To assess the effectiveness of a combined micro-credit and life-skills education intervention in reducing our secondary outcomes: high-risk risk behaviors (e.g., unprotected sex, number of partners, transactional sex, early sexual debut, sexual coercion and violence); 3) To examine the intermediary effects of increased economic opportunity and improved sexual negotiation skills in enhancing participants' control over sexual interactions, and 4) To evaluate whether characteristics related to participation, i.e., factors related to participant adherence, satisfaction, and understanding of the intervention mediate observed effects.