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

项目摘要 在非洲东部和南部的大部分地区，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不断扩大，但艾滋病毒/艾滋病的发病率仍然很高。最近的研究 记录了性交易的重要作用--金钱、物质支持或物品的交换-- 不同的性关系-以及酗酒在推动艾滋病毒/性传播感染发病率和影响男子和 妇女的健康结果。应对这一挑战的现有政策主要侧重于妇女， 采取各种干预措施，减少妇女参与性交易，如教育补贴， 职业培训和现金转移以增强经济权能。然而，这些措施的有效性 由于相对缺乏针对男子行为的方案，干预受到阻碍。有着重要 需要采取干预措施，减少男子参与增加艾滋病毒/性传播感染风险的危险行为。 该项目将测试一种创新的、理论上的经济干预，以减少男性的参与。 性交易和其他危险行为利用移动的金融服务的创新， 研究低收入国家的储蓄行为，我们的干预将激励高风险，赚取收入 肯尼亚的男性减少他们在危险行为上的支出，而是将他们的可支配收入储蓄在当地 银行账户这些银行账户将包括（a）以彩票为基础的额外储蓄奖励 与储蓄金额挂钩的奖励，（B）制定储蓄目标的机会，以及（c）定期提醒 动机和目标。通过直接的经济机制（鼓励将支出从 现在到未来）和心理机制（增加未来的方向），这种干预可以 产生显著的行为改变并改善健康结果。我们将进行一项随机对照 在高危男性中进行试验，以确定储蓄干预对其健康和经济的影响 成果。 该项目的具体目标如下。目标1：确定储蓄干预对 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 危险的健康行为。目的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。通过测试一种干预措施来促进- 在艾滋病毒/性传播感染高负担的环境中， 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.