HIV Intervention among Women at High Risk

描述（由申请人提供）：本研究是一项以同伴为主导的多水平、多成分HIV高危妇女干预的集群随机对照试验。主要目标是：(1)设计和实施将个人认知和社会影响方法与同伴教育相结合的艾滋病毒干预措施；(2)评价行为干预的效果；(3)确定HIV危险行为和行为改变的重要中介或调节因素。据估计，到2003年，中国将有84万人感染艾滋病毒，需要齐心协力防治艾滋病。这一流行病可能通过性传播迅速蔓延到一般人群，这一危险突出表明，迫切需要在目标人群中采取更有效和可持续的艾滋病毒干预措施，因为他们感染艾滋病毒的风险很高，也是艾滋病毒性传播的一个重要来源。然而，针对中国艾滋病高危妇女的干预措施很少。该研究的中心假设是，考虑到目标人群的边缘社会经济地位，艾滋病毒信息是必要的，但不足以改变行为；需要激励他们采取保护行动，相信自己有能力和技能处理困难情况，并在社会和工作环境中增强艾滋病毒行为改变的能力。艾滋病毒干预措施最有效的办法是由同伴进行小组会议，并注意行为改变的认知和社会过程以及文化和性别适当性。这种有效改变艾滋病毒行为的概念将在大约712名在娱乐行业工作的女性中进行测试和评估。参与者将通过整群随机抽样选择，其中每组为娱乐场所。将从抽样机构中招募所有符合条件的妇女，并按相同数量分配到干预组或对照组。两组都将接受标准的自愿咨询和测试（VCT）。但是，干预组将接受由训练有素的同伴教育者提供的额外动机增强和针对性别的赋权技能培训，并通过同伴外联和机构所有者的结构性干预部分加以加强，以促进有利于降低艾滋病毒风险的社会、规范和工作环境。干预的效果将通过干预后3个月、6个月和12个月对干预组和对照组之间自我报告的艾滋病毒风险和预防行为以及新发现的性传播感染进行评估。研究结果将对中国艾滋病高危妇女的有效预防干预具有深远的意义。中国的成功将反过来成为全球成功预防艾滋病传播的关键。

DESCRIPTION (provided by applicant): This study is a cluster-randomized controlled trial of a peer-led multilevel and multi-component HIV intervention among women at high risk. The main objectives are: (1) to design and implement an HIV intervention that combines individual cognitive and social influence approaches with peer education; (2) to evaluate the efficacy of such behavior intervention; and (3) to identify important mediating or moderating factors of HIV risk behavior and behavior change. With 840,000 people estimated to be infected with HIV by 2003, concerted efforts are needed to fight the AIDS epidemic in China. The danger that the epidemic can make a quick inroad to the general population through sexual transmission underscores the urgent need for more effective and sustainable HIV intervention among the target population, who are at high risk of acquiring HIV and a critical source of sexual transmission of HIV. However, few interventions have targeted women at high risk of HIV in China. The central hypothesis of the study is that, given the marginal socioeconomic status of the target population, HIV information is necessary but not sufficient for behavior change; they need to be motivated to take protective actions, be confident that they have the ability and skills to manage difficult situations, and in a social and working environment empowering of HIV behavior change. HIV intervention will be most effective if delivered in small group sessions by peers and attending to both cognitive and social processes of behavior change and cultural and gender appropriateness. This conceptualization of effective HIV behavior change will be tested and evaluated among about 712 women working in the entertainment industry. Participants will be selected through cluster-randomization sampling, in which the clusters are the entertainment establishments. All eligible women from the sampled establishments will be recruited and assigned with equal numbers to either an intervention or a control condition. Both groups will receive standard voluntary counseling and testing (VCT). But the intervention group will receive additional motivation enhancing and gender-specific empowerment skills trainings delivered by trained peer educators, augmented by peer outreach and a structural intervention component among owners of establishments to promote enabling social, normative, and working environments supportive of HIV risk reduction. The efficacy of the intervention will be evaluated through assessment of self-reported HIV risk and preventive behaviors and newly detected STIs at 3-, 6-, and 12-month post intervention between the intervention and the control groups. Findings will have far reaching implications for effective HIV prevention intervention among women at high risk in China. China's success will in turn be a key to global success in preventing the spread of HIV.