Alcohol, Gender, Power, and Condom use among Adults in Northern Tanzania

描述(申请人提供)：坦桑尼亚艾滋病毒/艾滋病的高流行率是一个严重的公共卫生问题。由于异性性行为是这一人群的主要传播途径，防止艾滋病毒传播的一种方法是使用男性乳胶避孕套。研究表明，作为预测避孕套使用行为的多因素变量网络的一部分，了解酒精使用、性别、人际关系能力和伴侣类型的影响对于制定有针对性的艾滋病毒预防干预措施至关重要，这些干预措施可以有效地降低高危人群(如坦桑尼亚妇女)新感染的风险。目前，完全缺乏解决这些因素对男性和女性使用避孕套能力的不同影响的实证研究，但有一个可检验的理论可用。性别与权力理论(TGP)将被用来生成关于酒精使用、感知的关系权力和伴侣类型对男性和女性自我报告的使用避孕套困难的不同影响的因果假设。这个项目有两个具体目标。首先是进行一项形成性研究，以创建和验证实验小场景，这些小场景可以用来提供可靠的衡量标准，以衡量在以下情况下使用避孕套的难度：(A)是否饮酒，(B)严重或随意的伴侣类型，以及(C)权力较低或同等的情况。第二个具体目标是利用前面描述的小插曲进行一项实验研究，以检验TGP产生的假说。来自坦桑尼亚北部的性行为活跃的男性和女性将通过指出在每种情况下讨论、谈判和实际使用避孕套有多“困难”，来回应一系列操纵感知的关系权力、伴侣类型和酒精使用的小插曲。预计妇女将报告说，在以饮酒、严重的性伴侣类型和权力不足为特征的情况下，最难使用避孕套。或者，对于男性来说，唯一会显著影响使用避孕套困难的变量是酒精，因此在男性饮酒的情况下，使用避孕套将更加困难。 与公共卫生的相关性：这项研究的结果将用于进一步了解坦桑尼亚北部高危、服务不足人群的避孕套使用行为。这一知识可用于提高艾滋病毒预防干预措施的有效性，从而减少目标人群中艾滋病毒感染的发生率。最后，该项目可作为提高撒哈拉以南非洲其他人口艾滋病毒预防干预措施有效性的实验工作的样板。

DESCRIPTION (provided by applicant): The high prevalence of HIV/AIDS in Tanzania is a critical public health issue. Because heterosexual sex is the predominant route of transmission among this population, one way to prevent the spread of HIV is through the use of a male latex condom. Research has indicated that understanding the influence of alcohol use, gender, relationship power, and partner-type as part of a multifacted network of variables that predict condom use behavior is essential to developing targeted HIV prevention interventions that can effectively reduce the risk of new infections among high-risk populations, such as women in Tanzania. Currently, there is a complete absence of empirical research that addresses the different effects of these factors on men and women's ability to implement condom use, but a testable theory is available. The Theory of Gender and Power (TGP) will be used to generate causal hypotheses about the differential influence of alcohol use, perceived relationship power, and partner-type on men and women's self-reported difficulty implementing condom use. This project has two specific aims. The first is to conduct a formative study to create and validate experimental vignettes that can be used to provide reliable measures of perceived difficulty engaging in condom use under circumstances characterized by (a) the presence or absence of alcohol use, (b) a serious or a casual partner-type, and (c) a situation of low or equal power. The second specific aim is to conduct an experimental study using the previously described vignettes to test hypotheses generated from the TGP. Sexually active men and women from Northern Tanzania will respond to a series of vignettes that manipulate perceived relationship power, partner-type, and presence of alcohol use by indicating how "difficult" in would be to discuss, negotiate, and actually engage in condom use in each scenario. It is expected that women will report that it is most difficult to engage in condom use in situations characterized by the presence of alcohol use, a serious partner-type, and low power. Alternatively, for men, the only variable that will significantly affect difficulty implementing condom use is alcohol, such that it will be more difficult to implement condom use in a scenario where the man had been drinking. Relevance to Public Health: The results from this study will be used to further understanding of condom use behavior among a high-risk, underserved population in Northern Tanzania. This knowledge can be used to enhance the effectiveness of HIV prevention interventions and thereby reduce the incidence of HIV infection in the target population. Finally, this project can be used as a model for experimental work that improves the effectiveness of HIV prevention interventions of other populations in Sub-Saharan Africa.