HIV/STI Prevention among Alcohol-Abusing Women in Mongolia

蒙古酗酒妇女的艾滋病毒/性传播感染预防

• 批准号: 7475836
• 负责人: Susan S Witte
• 金额: $ 19.12万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-01 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7475836
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adult; Age; Alcohol abuse; Alcohol consumption; Alcoholism; Alcohols; Anal Sex; Asia; Asians; Automobile Driving; Behavior; Behavior Therapy; Biological; Child; China; Clinical Trials; Cognitive Therapy; Collaborations; Commit; Communicable Diseases; Condition; Country; Diagnosis; Drug usage; Economics; Effectiveness; Employment; Epidemic; Foundations; Future; HIV; Heterosexuals; Individual; Infection prevention; Informed Consent; International; Intervention; Intervention Studies; Labor Forces; Life; Link; Manuals; Modeling; Mongolia; Numbers; Outcome; Pattern; Pilot Projects; Population; Poverty; Prevention; Prevention intervention; Prevention program; Prevention strategy; Probability; Prostitution; Public Health; Purpose; Randomized; Randomized Clinical Trials; Rate; Recording of previous events; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Research Support; Resources; Risk; Risk Behaviors; Risk Reduction; Route; Russia; Sampling; Schools; Science; Sexual Partners; Sexually Transmitted Diseases; Social Work; Societies; Staging; Stigmata; Substance abuse problem; Target Populations; Testing; Time; USSR; Universities; Unmarried; Unsafe Sex; Upper arm; Vagina; Woman; Work; base; cost; design; experience; follow-up; high risk sexual behavior; innovation; men; mental health center; migration; motivational enhancement therapy; prevent; programs; size; social; social stigma; theories; therapy development; transmission process

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.

描述（由申请人提供）：需要有针对性的、低成本的、经医学验证的预防干预措施，以帮助预防资源贫乏社会中妇女艾滋病毒/性传播感染的扩散。蒙古位于亚洲中心，与俄罗斯和中国接壤：这两个国家正在经历艾滋病毒流行的迅速蔓延。自1990年以来，蒙古经历了毁灭性的经济变化，导致超过36%的人口生活在贫困中，并使大量妇女失去劳动力。由于缺乏就业机会，越来越多的男子为寻找就业而在国内和国外移徙，沿着和贸易路线上从事谋生的性工作的妇女人数也大量增加。这种移徙模式与无保护的性交易和艾滋病毒/性传播感染的跨地域传播有关。与危险的异性恋行为的机会增加同时，酗酒和性传播感染的比率也在上升。在一般成年人口中，88%的男性和58%的女性报告饮酒。由于文化上的否认和耻辱，妇女酗酒的情况在很大程度上被低估了，但对48名最近有艾滋病毒/性传播感染风险行为的妇女进行的一项试点研究发现，85%的妇女有有害的饮酒行为。高达58%的25岁以下妇女至少被诊断患有一种性传播感染。有强有力的证据表明，在性传播感染的情况下，无保护的性接触会增加艾滋病毒传播的可能性，而且饮酒与性风险增加有关，这表明，如果不采取迫切需要的干预措施，蒙古很可能成为中亚区域艾滋病毒流行病的一个重要促成者。创新性地调整、采用和测试低成本、有针对性、经经验验证的预防干预措施，可能有助于防止蒙古艾滋病毒的上升。本研究旨在实现以下主要目标：1）调整并联合收割机，将4次降低艾滋病毒性风险干预（HIV-SRR）和2次动机访谈（MI）干预相结合，使其适合蒙古从事高风险性行为的酗酒妇女; 2）获得对联合干预的功效的初步估计通过对165名女性进行3组随机临床试验（RCT），将其分配至联合治疗组和非联合治疗组，（HIV-SRR+MI）或单一、时间匹配（HIV-SRR）风险降低干预或时间匹配健康促进（WP-C）条件; 3）检查并加强未来更大规模RCT的可行性，以测试目标人群中组合HIV-SRR+MI或单一组分HIV-SRR单独干预的疗效。将招募蒙古乌兰巴托国家艾滋病基金会方案的妇女客户。将在基线、干预后即刻以及3个月和6个月随访时完成研究评估。该研究将由哥伦比亚大学社会工作学院社会干预小组的Susan Witte博士和Nabila EI-Bassel博士与NAF、蒙古国家传染病中心和精神卫生和麻醉学中心合作进行。

项目成果

Reducing intimate and paying partner violence against women who exchange sex in Mongolia: results from a randomized clinical trial.

• DOI: 10.1177/0886260511431439
• 发表时间: 2012-07
• 期刊: Journal of interpersonal violence
• 影响因子: 2.5
• 作者: Carlson CE;Chen J;Chang M;Batsukh A;Toivgoo A;Riedel M;Witte SS
• 通讯作者: Witte SS

Reducing sexual HIV/STI risk and harmful alcohol use among female sex workers in Mongolia: a randomized clinical trial.

• DOI: 10.1007/s10461-011-9984-0
• 发表时间: 2011-11
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Witte, Susan S.;Altantsetseg, Batsukh;Aira, Toivgoo;Riedel, Marion;Chen, Jiehua;Potocnik, Katie;El-Bassel, Nabila;Wu, Elwin;Gilbert, Louisa;Carlson, Catherine;Yao, Hanfei
• 通讯作者: Yao, Hanfei