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

 描述(由申请人提供)：经济脆弱性导致居住在集中贫困地区的美国种族和少数民族感染艾滋病毒的风险。特别是，非洲裔美国人占美国新增艾滋病毒诊断病例的近一半，比其他美国种族和少数民族更有可能生活在高度贫困和艾滋病毒高流行的社区。令人担忧的是，年轻人的艾滋病毒感染率是美国所有年龄段中最高的，在城市无家可归者和失业人员中所占比例越来越大，这些因素往往与艾滋病毒和其他不利的健康和社会后果有关。有限的经济资源可能会在穷人中产生一种短期的迫切需要，即参与增加艾滋病毒脆弱性的高风险生存战略。贫困还可能导致失去希望和机构，从而削弱避免未来感染的动机。与传统的就业和现金奖励办法相比，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，很少有微型企业的干预措施适用于低收入的非裔美国年轻人。此外，行为经济学可能会通过加深我们对与性冒险相关的经济背景和动机的理解，来加强微型企业预防艾滋病毒战略的交付。因此，这项拟议的NIMH导师职业发展奖(K01)是独特的时机，为不断增长的经济加强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在边缘住房、失业和失学的高危非裔美国年轻人中加强微型企业干预以预防艾滋病毒的可行性和试点效果。这项干预的假设是通过以下方式减少性风险行为：提供安全性行为策略的技能；增加资产，将经济应激源降至最低，并激励保护性性行为；改善心理社会属性，提高安全性行为的自我效能和就业能力，而不是生存策略；以及转移对安全性行为策略的跨期奖励。这项建议的具体目标是：1)在预设计阶段，利用延迟折扣、损失厌恶和天赋效应等行为经济学原理，定性地检查与艾滋病毒保护性和危险性行为相关的动机；2)开发适应国际模式并纳入基于移动的行为经济学推动的艾滋病毒预防微型企业干预；以及3)初步测试强化微型企业干预在减少随机对照试验中危险性行为的可行性和纵向有效性。主要结果将是无保护措施的性行为的频率。次要结果将包括附加性风险行为、对艾滋病毒保护性行为和高风险性行为的成本和回报的态度、心理社会属性、创业活动和经济结果。将使用纵向分析来估计重复措施的水平和趋势在一段时间内的差异。在小额信贷、艾滋病毒预防科学、经济赋权、行为经济学、生物统计学和移动健康等多学科专家团队的指导下，詹宁斯博士为这个拟议的职业发展奖提供的培训目标是获得以下技能：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)纵向数据分析的统计；以及4)在与健康相关的研究中使用移动技术。这项拟议的研究将提供培训和有指导的研究经验，为詹宁斯博士的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来降低艾滋病毒的易感性。

 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.