A savings intervention to reduce men's engagement in HIV risk behaviors

项目摘要 在东部和南部非洲的大部分地区，艾滋病毒和其他性传播感染的发病率 尽管有希望的生物医学和行为干预措施的规模扩大，但仍居高不下。最近的研究表明 记录了交易性行为的关键作用--金钱、物质支持或商品的交换-- 不同的性关系和大量饮酒导致艾滋病毒/性传播感染的发病率，并影响男性和 妇女的健康结果。针对这一挑战的现有政策对策主要侧重于妇女， 减少妇女参与交易性行为的各种干预措施，如教育补贴， 职业培训和现金转移以增强经济能力。然而，这些措施的有效性 由于相对缺乏针对男性行为的项目，干预受到了阻碍。有一个至关重要的 需要采取干预措施，减少男性参与增加艾滋病毒/性传播感染风险的危险行为。 该项目将测试一种创新的、以理论为动机的经济干预措施，以减少男性的参与度 在交易性行为和其他危险行为中。利用移动金融服务和 对低收入国家储蓄行为的研究，我们的干预将激励高风险、高收入的人 肯尼亚男性减少在危险行为上的支出，转而将可支配收入存到当地 银行账户。这些银行账户将包括：(A)以彩票形式储蓄的额外奖励 与节省金额挂钩的奖励，(B)制定储蓄目标的机会，以及(C)定期提醒 激励措施和目标。通过直接经济机制(激励将支出从 现在)和一种心理机制(增加面向未来)，这种干预可以 产生重大的行为改变并改善健康结果。我们将进行随机对照 在高危男性中进行试验，以确定储蓄干预对他们健康和经济的影响 结果。 该项目的具体目标如下。目标1：确定储蓄干预对以下方面的影响 艾滋病毒和其他性传播感染的发病率。目标2：确定干预措施对储蓄和支出的影响 作为危险的健康行为。目标3：定量和定性评估行为改变的机制 在参与者和女性伴侣的样本中进行调查。通过测试一种干预措施来促进未来- 在艾滋病毒/性传播感染负担较高的情况下，观察行为并降低感染艾滋病毒和其他性传播疾病的风险，这 该项目具有很高的科学和公共卫生影响潜力。

Project Abstract In much of eastern and southern Africa, the incidence of HIV and other sexually transmitted infections (STIs) remains high despite the scale-up of promising biomedical and behavioral interventions. Recent studies have documented the crucial role of transactional sex – the exchange of money, material support or goods in age- disparate, sexual relationships – and heavy alcohol use in driving HIV/STI incidence and influencing men's and women's health outcomes. Existing policy responses to this challenge have largely focused on women, with various interventions to reduce women's engagement in transactional sex such as education subsidies, vocational training, and cash transfers for economic empowerment. However, the effectiveness of these interventions has been hindered by the relative lack of programs that target men's behavior. There is a vital need for interventions that can reduce men's engagement in risky behaviors that increase HIV/STI risk. This project will test an innovative, theoretically-motivated economic intervention to reduce men's engagement in transactional sex and other risky behaviors. Leveraging innovations in mobile financial services and research on savings behavior in low-income countries, our intervention will motivate high-risk, income-earning men in Kenya to reduce their spending on risky behaviors and instead save their disposable income in local bank accounts. These bank accounts will include (a) additional incentives to save in the form of lottery-based rewards linked to amounts saved, (b) opportunities to develop savings goals, and (c) periodic reminders about the incentives and goals. Through a direct economic mechanism (incentives to shift expenditures from the present to the future) and a psychological mechanism (increasing future orientation), this intervention can generate significant behavior change and improve health outcomes. We will conduct a randomized controlled trial among high-risk men to determine effects of the savings intervention on their health and economic outcomes. Specific aims of the project are as follows. Aim 1: Determine the impact of the savings intervention on incidence of HIV and other STIs. Aim 2: Determine intervention impacts on savings and expenditures as well as risky health behaviors. Aim 3: Quantitatively and qualitatively assess mechanisms of behavior change among participants and among a sample of female partners. By testing an intervention to promote forward- looking behavior and reduce the risk of acquiring HIV and other STIs in a high HIV/STI burden setting, this project has high potential for scientific and public health impact.