Evaluating a Microfinance Intervention for High Risk Women in Kazakhstan

描述(申请人提供)：这项拟议的研究将审查艾滋病毒和小额信贷联合干预措施的有效性，以减少在哈萨克斯坦泰米尔陶和巴甫洛达尔的520名在过去一年中注射毒品并从事性交易的妇女中生物确诊的性传播感染(STI)、艾滋病毒和丙型肝炎的新发病率以及报告的性和毒品危险行为。在过去十年中，世界上有九个国家的艾滋病毒感染率持续上升，哈萨克斯坦就是其中之一。贫困和吸毒者，尤其是女性吸毒者缺乏就业选择等结构性力量加剧了这一流行病，这使得交易性行为成为一种生存战略。最近呼吁艾滋病毒预防科学家采取行动，强调有必要对性工作中也涉及毒品的妇女采取创新的结构性干预措施。这项拟议的研究建立在调查小组测试艾滋病毒预防和小额信贷干预组合的R34结果的基础上。根据成功的方案和显著的结果，我们将从哈萨克斯坦的特米尔陶和巴甫洛达尔随机分配520名注射毒品和从事性交易的女性，要么(1)接受4节艾滋病预防干预，同时进行6节金融知识干预，参加现有的职业培训计划并获得匹配储蓄(HIVRR+MF)；或者只接受4节艾滋病预防干预。HIVRR干预以社会认知理论为指导。HIVRR+MF干预将资产理论与社会认知理论相结合。MF包括：1)金融知识；2)职业培训；3)小额储蓄，以支持过渡到更永久的就业状态。我们假设，与没有小额信贷干预的HIVRR干预相比，提高金融知识、提高填补当地经济中有市场的职位所需的职业技能，以及启动个人储蓄计划，结合降低艾滋病毒风险，将导致研究结果显著减少。研究促进或阻碍妇女参与小额信贷干预并从中受益的因素的定性部分，以及成本和成本效益分析将提供额外的数据，以便在调查结果显著时为可传播的方案提供信息。 这项研究的发现不仅对中亚地区很重要，而且可能对美国和其他国家的公共卫生产生重要影响，在这些国家，艾滋病毒/性传播感染和丙型肝炎病毒仍然很高，而涉毒女性从事性交易的就业率仍然很低。

DESCRIPTION (provided by applicant): The proposed study will examine the efficacy of a combined HIV and microfinance intervention to reduce biologically confirmed sexually transmitted infections (STIs), and new incidence of HIV and HCV, as well as reported sexual and drug risk behaviors among 520 women who have injected drugs in the past year and who engage in sex trading in Temirtau and Pavlodar, Kazakhstan. Kazakhstan is one of nine countries worldwide that has experienced a continuing rise in HIV infections (>25%) over the past decade. The epidemic is exacerbated by structural forces such as poverty and a lack of employment options for people who use drugs, especially women, which makes transactional sex a survival strategy. Recent calls for action by HIV prevention scientists have emphasized the need for innovative structural interventions for women engaged in sex work who are also drug-involved. The proposed study builds on findings from an R34 by the investigative team testing a combination HIV prevention and microfinance intervention. Building on successful protocols and significant results, we will randomly assign 520 women who inject drugs and engage in sex trading from Temirtau and Pavlodar, Kazakhstan to either (1) a 4 session HIV prevention intervention combined with a 6 session financial literacy intervention, enrollment in an existing vocational training program and receipt of matched savings (HIVRR+MF); or to the 4 session HIV prevention intervention alone. The HIVRR intervention is guided by social cognitive theory. The HIVRR+MF intervention integrates asset theory with social cognitive theory. The MF includes: 1) financial literacy; 2) vocational training; and 3) micro-savings to support transitionto a more permanent employment status. We hypothesize that increasing financial literacy, enhancing vocational skills required to fill marketable positions in the local economy, and beginning a personal savings program, combined with HIV risk reduction, will lead to significant reductions in study outcomes compared to an HIVRR intervention without a microfinance intervention. A qualitative component to examine factors that facilitate or impede women's ability to participate in and benefit from a microfinance intervention, and a cost and cost effectiveness analysis will provide additional data to inform a disseminable program if findings are significant. The findings from this study will be important not only for Central Asia, but may also have vital public health implications in the U.S. and other countries where HIV/STIs and HCV remain high and employment rates remain low among drug- involved women engaged in sex trading.