Economic Opportunity for Zimbabwean Adolescent Orphans

说明(申请人提供)：该项目的总体目标是采用随机对照设计，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措施是否能防止津巴布韦16-19岁失学女孤儿发生无保护措施性行为的不良后果。这项干预是在我们最近完成的评估此类计划可行性的研究的基础上进行的，将评估其对包括艾滋病毒在内的性传播感染以及意外怀孕的影响。干预措施包括一个综合的小额信贷计划，包括创业培训、贷款提供、实用的商业教育、导师指导和同行支持小组。这将与之前经过测试的FIFE技能教育课程相结合，通过使用角色扮演、绘画练习和其他技术来提供艾滋病毒/生殖健康教育，以帮助参与者谈判他们的性关系条款。为了评估这种超越生活技能的综合干预的效果，控制组将接受吹奏技能教育课程、“安慰剂”健康和营养培训，以及持续的同伴支持小组。尽管这种经济和生活技能相结合的方案在改善女性青少年孤儿的生殖健康方面有很大的潜力，但到目前为止还没有研究评估这种干预措施对这一或任何其他高危人群的性危险行为、性传播感染/艾滋病毒或妊娠结局的影响。我们的干预是以因果模型为指导的，在该模型中，提供经济替代方案和机会(通过小额信贷干预)和性谈判技能(通过生活技能干预)是加强对性行为互动的控制，从而减少高危行为和不良生物后果的驱动力。这个项目的具体目标是：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：单纯疱疹病毒2型(HSV2)和意外怀孕的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减少我们的次要结果：高危行为(例如，无保护措施的性行为、伴侣数量、交易性行为、早出性行为、性胁迫和暴力)方面的有效性；3)考察更多的经济机会和提高的性谈判技巧在增强参与者对性互动的控制方面的中介效应，以及4)评估与参与相关的特征，即与参与者遵守、满意和对干预的理解相关的因素是否中介了观察到的效果。

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.