HIV/STI Prevention among Alcohol-Abusing Women in Mongolia

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DESCRIPTION (provided by applicant): Targeted, low cost, empirically-validated prevention interventions are needed to help prevent the proliferation of HIV/STIs among women in resource poor societies. Centrally located in Asia, Mongolia is bordered by Russia and China: two countries experiencing rapidly expanding HIV epidemics. Since 1990, Mongolia has endured devastating economic changes leading to over 36% of the population living in poverty, and driving a disproportionate number of women out of the labor force. Lack of employment has resulted in increases in internal and external migration among men in search of employment and a great increase in the number of women engaging in survival sex work along borders and trade routes. Such migration patterns have been linked with unprotected sex exchange transactions and transmission of HIV/STIs across geographic boundaries. Concurrent with increasing opportunities for risky heterosexual behaviors are rising rates of alcoholism and sexually transmitted infections (STIs). In the general adult population, 88% of men and 58% of women report alcohol use. Alcohol abuse among women is largely underreported due to cultural denial and stigma, but a pilot study among 48 women engaging in recent HIV/STI sexual risk behaviors found that 85% were engaged in harmful alcohol use. Up to 58% of women under the age of 25 have at least one diagnosed STI. Strong evidence that unprotected sexual contact in the presence of STIs enhances the probability of HIV transmission and that alcohol use is associated with increased sexual risk suggests that, without urgently needed interventions, Mongolia is poised to become a significant contributor to the regional Central Asian HIV epidemic. Innovative adaptation, introduction and testing of low cost, targeted, empirically validated prevention interventions may help prevent the rise of HIV in Mongolia. The proposed study is designed to achieve the following primary aims: 1) to adapt and combine a 4- session HIV sexual risk reduction intervention (HIV-SRR) and a 2-session motivational interviewing (Ml) intervention and tailor them to alcohol-abusing women who engage in high risk sexual behaviors in Mongolia; 2) to obtain preliminary estimates for the efficacy of the combined intervention (HIV-SRR+MI) on reduction in sexual risk behaviors by conducting a 3-arm randomized clinical trial (RCT) with 165 women, assigned to either a combination (HIV-SRR+MI) or single, time-matched (HIV-SRR) risk reduction intervention or a time-matched wellness promotion (WP-C) condition; and 3) to examine and enhance the feasibility of a future, larger-scale RCT testing the efficacy of the combination HIV-SRR+MI or single component HIV-SRR only interventions among the target population. Women clientele of the National AIDS Foundation (NAF) program in Ulaanbaatar, Mongolia will be recruited. Study assessments will be completed at baseline, immediately post-intervention, and 3 and 6 month follow-up. In partnership with the NAF, the Mongolian National Center for Communicable Diseases and the Center of Mental Health and Narcology, the study will be conducted by Drs. Susan Witte and Dr. Nabila EI-Bassel of the Social Intervention Group at the Columbia University School of Social Work.