Women-Focused HIV Prevention in the Western Cape

西开普省以妇女为重点的艾滋病毒预防

• 批准号: 7503974
• 负责人: WENDEE M WECHSBERG
• 金额: $ 60.79万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7503974
• 关键词: AIDS prevention; AIDS/HIV problem; Address; African; Alcohol or Other Drugs use; Assertiveness; Attention; Biological; Biological Testing; Cessation of life; Cocaine; Color; Communities; Complement; Control Groups; Counseling; Drug usage; Effectiveness; Epidemic; Evaluation; Female; Female of child bearing age; Focus Groups; HIV; HIV Infections; HIV Seropositivity; Health; Heroin; Heterosexuals; Indigenous; Individual; Intervention; Knowledge; Link; Mandrax; Marijuana; Measures; Mediating; Mediation; Methamphetamine; Methaqualone; Methods; Multiple Partners; Neonatal; Numbers; Participant; Pharmaceutical Preparations; Pilot Projects; Province; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Rate; Recruitment Activity; Relative (related person); Reporting; Research; Research Methodology; Risk; Risk Behaviors; Sampling; Sexually Transmitted Diseases; South Africa; Substance abuse problem; Surveys; Testing; Training; Unsafe Sex; Victimization; Violence; Woman; base; cohesion; condoms; design; drug market; ecstasy; high risk sexual behavior; male; nutrition; outreach; sex risk; skills; transmission process; violence against women

DESCRIPTION (provided by applicant): Results from a 2005 antenatal survey conducted in all nine South African provinces indicate that the Western Cape Province had the highest rate of increase of HIV infection among all provinces: from 13.1% in 2003 to 15.7% in 2005. Among Black African and Coloured women, noninjecting drug use is associated with high-risk sexual behavior, HIV seropositivity, and sexually transmitted infections (STIs). In addition, violence against women is widespread in South Africa, which further exacerbates their HIV risks. A recent pilot study conducted in the Western Cape townships explored an evidence-based woman-focused intervention to reduce drug use, sexual risk, and victimization by addressing the intersection of these factors among poor, substance-using women. The pilot study explored the feasibility and promise of the woman-focused intervention in both an individual and group-based format through a small randomized trial. Both Black African and Coloured women reported high levels of substance abuse, as well as high levels of sexual risk behavior (e.g., multiple partners and unprotected sex) and victimization. Findings from the pilot study suggest that women reduced substance use (with biological verification), sexual risk behavior, and victimization. The group intervention, however, created an ongoing effect in the community in which women who participated in the two group sessions continued to meet after the study ended to provide support for one another and reinforce positive changes. The group format complemented the strong sense of community cohesion intrinsic to the Western Cape townships. The proposed revised study builds on this pilot study and is designed to reach a larger sample of women via a full-scale effectiveness study by adding a woman-focused intervention after voluntary counseling and testing (VCT). This multi-method research will conduct an extensive evaluation using qualitative and quantitative methods, repeated measures, and biological testing to determine the effectiveness of the woman-focused intervention to increase knowledge and skills to reduce substance abuse, sexual risk behaviors, and victimization. Former pilot study participants indigenous to the target communities will be trained as outreach workers to screen, recruit, and track 900 female study participants. The primary aim of the study is: Aim 1. To test the effectiveness, through a randomized controlled trial, of VCT plus a woman-focused intervention relative to VCT only to increase knowledge and skills to reduce substance abuse, sexual risk, and victimization, and to an equal-attention (nutrition) control group at 3-, 6-, 9-, and 12-month follow-ups. The secondary aim of the study is as follows: Aim 2. To examine the moderating effect of victimization (i.e., sexual and physical) and the mediating effects of HIV risk knowledge, condom use skills, sexual negotiation assertiveness, and relationship power on the effectiveness of the woman-focused groups to decrease risk related to drug use, sexual risk, and sex-related- victimization relative to the rapid testing group and to the equal-attention control group.

说明(申请人提供)：2005年在南非所有9个省进行的产前调查结果表明，在所有省份中，西开普省的艾滋病毒感染率最高：从2003年的13.1%上升到2005年的15.7%。在非洲黑人和有色人种妇女中，非注射毒品的使用与高危性行为、艾滋病毒血清阳性和性传播感染(STI)有关。此外，南非普遍存在针对妇女的暴力行为，这进一步加剧了她们感染艾滋病毒的风险。最近在西开普省进行的一项试点研究探索了一种以循证妇女为重点的干预措施，通过解决贫穷、吸毒妇女之间的这些因素的交集来减少吸毒、性风险和受害。这项初步研究通过一项小型随机试验，探索了以妇女为中心的个人和小组形式干预的可行性和前景。据报告，非洲黑人和有色人种妇女滥用药物的程度很高，性危险行为(例如，多个伴侣和无保护的性行为)和受害程度也很高。这项初步研究的结果表明，女性减少了物质使用(通过生物验证)、性危险行为和受害。然而，小组干预在社区中产生了持续的影响，参加了两个小组会议的妇女在研究结束后继续会面，相互支持，加强积极的变化。小组形式补充了西开普省城镇固有的强烈的社区凝聚感。拟议的修订研究建立在这项初步研究的基础上，旨在通过一项全面的有效性研究，在自愿咨询和测试(VCT)之后增加一项以妇女为重点的干预措施，从而覆盖更多的妇女样本。这项多方法研究将使用定性和定量方法、重复测量和生物测试进行广泛的评估，以确定以妇女为重点的干预措施的有效性，以增加减少药物滥用、性危险行为和受害的知识和技能。目标社区原住民的前试点研究参与者将接受培训，担任外展工作人员，以筛选、招募和跟踪900名女性研究参与者。这项研究的主要目的是：1.通过随机对照试验，测试VCT加以女性为中心的干预措施的有效性，相对于VCT只增加减少药物滥用、性风险和受害的知识和技能，并在3个月、6个月、9个月和12个月的随访中测试同等关注(营养)对照组的有效性。本研究的第二个目的如下：目的2.与快速检测组和同等注意控制组相比，研究受害(性和身体)的调节效应以及艾滋病毒风险知识、避孕套使用技巧、性谈判自信和关系权力对以妇女为中心的群体降低与药物使用、性风险和性相关受害有关的风险的有效性的中介效应。