Economic Opportunity for Zimbabwean Adolescent Orphans

描述（由申请人提供）：该项目的总体目标是确定，使用随机对照设计，是否创新的经济和生活技能干预，旨在增加对性行为的控制，防止在津巴布韦16-19岁的失学女孤儿中发生无保护性行为的不良后果。该干预措施建立在我们最近完成的评估此类计划可行性的研究基础上，将评估其对性传播感染（包括艾滋病毒）以及意外怀孕的影响。干预措施包括一个综合性的小额信贷方案，其中包括企业家培训、提供贷款、实用商业教育、指导和同伴支助小组。这将与以前测试过的五项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提供艾滋病毒/生殖健康教育，以帮助参与者谈判其性关系的条款。为了评估这种综合干预措施在生活技能之外的效果，对照组将接受五项技能教育课程，“安慰剂”健康和营养培训，以及持续的同伴支持小组。虽然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具有很大的潜力，但迄今为止还没有研究评估这种干预措施对这一群体或任何其他风险群体的性风险行为、性传播感染/艾滋病毒或怀孕结果的影响。我们的干预是由一个因果模型，其中提供经济替代品和机会（通过小额信贷干预）和性谈判技能（通过生活技能干预）是增加对性互动控制的驱动力，从而减少高风险行为和不良生物后果。该项目的具体目标是：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发生率方面的有效性：单纯疱疹病毒2型（HSV 2）和意外怀孕; 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方面的有效性：高风险风险行为（例如，无保护的性行为，伴侣数量，性交易，早期性初次，性胁迫和暴力）; 3）检查增加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作用，以及4）评估是否与参与有关的特征，即，与参与者依从性、满意度和对干预措施的理解相关的因素介导了观察到的效果。

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.