BRIEF HIV INTERVENTIONS FOR DRUG-USING WOMEN SEX WORKERS

这项拟议的为期5年的迈阿密研究的动机是，需要为吸毒的女性性工作者开发和评估一种降低艾滋病毒/丙型肝炎/乙肝病毒风险的替代模式，该模式简短、成本效益高、易于复制，而且超越了纯粹的说教、专家设计的信息。将积极的性工作者培训为外展工作者，将前性工作者培训为艾滋病毒/丙型肝炎病毒/乙肝病毒干预者，并与社区成员一起设计适当的干预措施，是增强女性性工作者控制自己减少风险活动的能力的方法。因此，这项研究的总体目的是：1)通过随机将800名参与者分配到两种治疗条件之一来实施和评估两种干预措施的有效性：a)与街面性工作者一起开发的、由前性工作者提供的以性工作者为重点的干预措施；b)由前性工作者提供的传统干预措施(扩大的“NIDA标准”)；2)检查人口统计学和其他变量在预测性、毒品和其他危险行为变化方面的影响；3)检验让性工作者进行外展的适宜性，以及使用正在康复的前性工作者提供拟议的干预措施；4)评估这两种干预措施在减少性和毒品危险行为方面的成本和成本效益。该项目的实地地点将位于迈阿密主要卖淫地区的中心，并进行了广泛的试点工作，以告知以性工作者为重点的干预措施的发展情况和整个提案。样本包括非洲裔美国人、白人盎格鲁人和拉丁裔，比例与他们在迈阿密活跃的性工作者人口中的估计比例。数据分析将使用各种统计技术来描述人口和危险行为的流行率。随后的分析将使用先进的多变量技术来评估危险行为的变化。提出了一项强有力的出版和技术转让计划。

The proposed 5-year, Miami-based study is motivated by the need to develop and evaluate an alternative model of HIV/HCV/HBV risk reduction for drug-using women sex workers that is brief, cost- effective, easily replicable, and that goes beyond a purely didactic, expert-designed message. Training active sex workers as outreach workers and former sex workers as HIV/HCV/HBV interventionists, and designing an appropriate intervention together with members of this community are ways of empowering women sex workers to control their own risk reduction activities. As such, the general purposes of the study are to: 1) implement and evaluate the effectiveness of two interventions by randomly assigning 800 participants to one of two treatment conditions: a) a sex worker-focused intervention developed in conjunction with street-based sex workers and delivered by former sex workers; and b) a conventional intervention (the augmented "NIDA Standard") delivered by former sex workers; 2) examine the effects of demographics and other variables in predicting changes in sexual, drug, and other risk behaviors; 3) examine the suitability of using active sex workers for outreach, and using former sex workers now in recovery for delivering the proposed interventions; 4) evaluate the cost and cost-effectiveness of the two interventions in reducing sexual and drug risk behaviors. The field site for the project will be located in the heart of Miami's major prostitution districts, and extensive pilot work was conducted to inform the development of the sex worker focused intervention and the proposal as a whole. The sample includes African-Americans, white-Anglos, and Latinas in proportion to their estimated representation in the active Miami sex worker population. Data analyses will use a variety of statistical techniques to describe the population and the prevalence of risk behaviors. Subsequent analyses will use advanced multivariate techniques to assess changes in risk behaviors. A vigorous publication and technology transfer program is proposed.