Integrating Microenterprise and Behavioral Economics for HIV Prevention in African-American Young Adults

 描述（由申请人提供）：经济脆弱性导致生活在贫困集中地区的美国少数族裔面临艾滋病毒风险。特别是，非洲裔美国人占美国所有新艾滋病毒诊断的近一半，并且比美国其他种族和族裔更有可能生活在高度贫困和艾滋病毒高流行社区。令人担忧的是，年轻人的艾滋病毒感染率是美国所有年龄组中最高的，并且在城市无家可归和失业者中所占比例越来越大，这些因素通常与艾滋病毒和其他不良健康和社会后果有关。有限的经济资源可能会导致穷人在短期内迫切需要采取高风险的生存策略，从而增加艾滋病毒的脆弱性。贫困还会导致失去希望和动力，从而削弱避免未来感染的动力。与传统的就业和现金激励方法相比，微型企业的发展可能会对艾滋病毒风险的经济驱动因素产生更长期的影响。然而，很少有微型企业干预措施适用于低收入非裔美国年轻人。此外，行为经济学可以通过加深我们对经济背景和与性冒险相关的动机的理解来加强艾滋病毒预防的微型企业战略的实施。因此，拟议的 NIMH 指导职业发展奖 (K01) 恰逢其时，旨在为不断发展的经济强化和艾滋病毒预防领域做出贡献。在资产和行为经济学理论的指导下，詹宁斯博士的目标是开发和测试强化微型企业干预措施的可行性和试点效果，以预防住房条件差、失业和失学的高危非洲裔美国年轻人的艾滋病毒预防。假设干预措施可以通过以下方式减少性危险行为： 提供安全性行为策略的技能；增加资产，最大限度地减少经济压力并激发保护性性行为；改善心理社会属性，提高安全性行为自我效能和就业能力，而不是生存策略；并将跨期奖励转变为更安全的性行为策略。该提案的具体目标是：1）在预设计阶段，利用延迟贴现、损失厌恶和禀赋效应的行为经济学原理，定性检查与艾滋病毒保护性行为和危险性行为相关的动机； 2) 根据国际模式制定艾滋病毒预防微型企业干预措施，并纳入基于移动的行为经济推动； 3) 在随机对照试验中试点测试增强微型企业干预措施在减少危险性行为方面的可行性和纵向有效性。主要结果是无保护性行为的频率。次要结果将包括额外的性风险行为、对艾滋病毒保护性行为和危险性行为的成本和回报的态度、社会心理属性、创业活动和经济成果。纵向分析将用于估计随时间推移重复测量的水平和趋势的差异。在小额信贷、艾滋病毒预防科学、经济赋权、行为经济学、生物统计学和移动医疗等领域的多学科专家团队的指导下，詹宁斯博士的职业发展奖的培训目标是获得以下方面的技能：1）行为经济学方法和理论； 2）微型企业干预措施的开发和测试； 3）纵向数据分析统计； 4) 在健康相关研究中使用移动技术。拟议的研究将提供培训和指导研究经验，帮助詹宁斯博士为独立研究生涯做好准备，旨在通过加强美国和世界各地城市贫困非裔美国人和其他种族和少数民族年轻人的经济干预措施来减少艾滋病毒脆弱性。

 DESCRIPTION (provided by applicant): Economic vulnerability contributes to HIV risk among U.S. racial and ethnic minorities living in concentrated areas of poverty. In particular, African-Americans disproportionately account for nearly half of all new HIV diagnoses in the U.S. and are more likely than other U.S. racial and ethnic minorities to live in high poverty and high HIV prevalence communities. Of concern is that young adults have the highest HIV rates of all U.S. age groups and make up an increasing proportion of the urban homeless and unemployed, factors often associated with HIV and other adverse health and social outcomes. Limited economic resources can create a short-term imperative among the poor to engage in high-risk survival strategies that increase HIV vulnerability. Poverty can also lead to a loss of hope and agency that diminish motivations to avoid exposure to future infection. Microenterprise development may sustain longer-term effects on economic drivers of HIV risk than traditional employment and cash incentive approaches. Yet, few microenterprise interventions have been adapted for low-income African-American young adults. Furthermore, behavioral economics may enhance the delivery of microenterprise strategies for HIV prevention by deepening our understanding of economic contexts and motivations associated with sexual risk-taking. As such, this proposed NIMH Mentored Career Development Award (K01) is uniquely timed to contribute to the growing field of economic-strengthening and HIV prevention. Guided by asset and behavioral economic theories, Dr. Jennings' goal is to develop and test the feasibility and pilot efficacy of an enhanced microenterprise intervention for HIV prevention among high-risk African-American young adults who are marginally housed, unemployed, and out of school. The intervention is hypothesized to reduce sexual risk behaviors by: providing skills on safer sex strategies; increasing assets that minimize economic stressors and motivate protective sexual behaviors; improving psychosocial attributes that enhance safer sex self-efficacy and employability in lieu of survival strategies; and shifting intertemporal rewards for safer sex strategies. The specific aims of this proposal are: 1) in a pre-design phase, qualitatively examine motivations associated with HIV protective and risky sexual behaviors using the behavioral economic principles of delay discounting, loss aversion, and endowment effect; 2) to develop a HIV prevention microenterprise intervention adapted from international models and incorporating mobile-based behavioral economic nudges; and 3) to pilot test the feasibility and longitudinal efficacy of an enhanced microenterprise intervention in reducing risky sexual behaviors in an RCT. The primary outcome will be frequency of unprotected sexual acts. Secondary outcomes will include additional sexual risk behaviors, attitudes on costs and rewards of HIV protective and risky sexual behaviors, psychosocial attributes, entrepreneurial activity, and economic outcomes. Longitudinal analyses will be used to estimate differences in the level and trend of repeated measures over time. Guided by a multidisciplinary team of experts in microfinance, HIV prevention science, economic empowerment, behavioral economics, biostatistics, and mobile health, Dr. Jennings' training objectives for this proposed career development award are to gain skills in: 1) behavioral economic methods and theories; 2) development and testing of microenterprise interventions; 3) statistics for longitudinal data analyses; and 4) use of mobile technology in health-related research. The proposed research will provide training and mentored research experience to prepare Dr. Jennings for an independent research career aiming to reduce HIV vulnerability through economic-strengthening interventions among urban poor African-American and other racial and ethnic minority young adults in the U.S. and worldwide.