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）：需要采取针对性，低成本，经验验证的预防干预措施，以帮助防止资源贫困社会中妇女中艾滋病毒/性传播感染的扩散。蒙古人位于亚洲的中央位置与俄罗斯和中国接壤：两个迅速扩大艾滋病毒流行病的国家。自1990年以来，蒙古遭受了毁灭性的经济变化，导致超过36％的人口居住在贫困中，并使数量不成比例的妇女离开劳动力。缺乏就业导致男性内部和外部迁徙的增加，以寻求就业，并大大增加了从事边界和贸易路线生存性工作的妇女人数。这种迁移模式与未受保护的性交交易和跨地理边界的HIV/性传播症的传播有关。与危险的异性恋行为的越来越多的机会同时发生的是酒精中毒和性传播感染的速度上升（STIS）。在一般成年人口中，有88％的男性和58％的女性报告了酒精的使用。由于文化否认和污名，妇女的酗酒在很大程度上被低估了，但是对最近从事HIV/STI性风险行为的48名妇女进行了一项试点研究，发现有85％的人从事有害的酒精饮酒。 25岁以下的妇女中，多达58％的女性至少有一个被诊断的性传播感染。有力的证据表明，在存在性传播感染的情况下，无保护的性接触增强了艾滋病毒传播的可能性，并且饮酒与增加的性风险有关，这表明，如果没有急需干预措施，蒙古有望成为中亚艾滋病毒地区的重要贡献者。针对性，经验验证的预防干预措施的创新适应性，引入和测试可能有助于防止蒙古艾滋病毒的兴起。拟议的研究旨在实现以下主要目的：1）适应和结合4次会议的HIV HIV性风险减少干预措施（HIV-SRR）和2条经验的动机访谈（ML）干预（ML）干预措施（ML），并将其定制为滥用酒精的妇女，这些妇女从事蒙古的高风险性行为； 2）通过对165名女性进行3臂随机临床试验（RCT）进行组合干预（HIV-SRR+MI）对性风险行为减少的功效的初步估计，分配给组合（HIV-SRR+MI）（HIV-SRR+MI）或单一，时间匹配（HIV-SRR）（HIV-SRR）的风险促进或促进时间，或促进时间较高或时间促进时间，以促进良好的情况（均为时间）。 3）要检查和增强未来大规模RCT的可行性，以测试HIV-SRR+MI组合的功效或仅在目标群体中仅干预HIV-SRR的单一组件。将招募在蒙古Ulaanbaatar的国家艾滋病基金会（NAF）计划的女性客户。研究评估将在基线，干预后立即完成以及3个月的随访。与NAF，蒙古国家传染病中心以及心理健康和纳学中心合作，该研究将由博士进行。哥伦比亚大学社会工作学院社会干预小组的Susan Witte和Nabila Ei-Bassel博士。

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