Venue-Based Recruitment and HIV Prevention for AOD Using Couples in South Africa

描述（由申请人提供）：以前在南非的研究已经确定了酗酒问题，性风险和基于性别的暴力是高流行的相关行为。研究表明，通过技能建设活动提高自我效能的授权干预措施减少了危险行为。然而，关于干预措施如何解决男性和女性之间这些危险行为的相互关系以及这些行为如何受到环境因素（例如，人们饮酒的地点，这些饮酒场所及其周围的暴力行为以及社区特征）的影响，在知识方面仍然存在很大差距。这表明有必要测试针对发生这些危险行为的饮酒场所顾客的干预措施，并在这些场所附近开展艾滋病毒预防干预措施，以挑战社区行为。为了满足这一需求，本方案通过地理信息系统（GIS）对三个研究条件进行映射，从随机街区的饮酒场所进行基于场所的招募。拟议中的美国和南非调查小组将在其初步研究的基础上，解决这些相互关联的风险行为，首先关注环境背景，并将拟议的社区群体随机试验干预措施细化为三种干预条件之一，其中个人评估、艾滋病毒检测和群体干预将在饮酒场所外的移动单元中进行。三个干预措施分别是条件1：男性对照组和女性合作社；条件2：男性为合作伙伴，女性为合作社；和条件3-男性作为合作伙伴，女性合作社和夫妻会议。妇女合作社和夫妇都是国际上采用的基于证据的艾滋病毒干预措施。“男人是伙伴”活动在南非以及世界各地开展。本建议的具体目标是：目标1。在南非开普敦的两个大型黑人/非洲人和有色人种社区的抽样街区中，描述饮酒场所的类型（例如，执照状态和规模），其直接背景（例如，观察到的其他药物的可用性，暴力和性活动）以及周围社区特征（例如，饮酒场所的数量）。目标2。通过定性方法完善与技能建设相关的拟议干预措施，以解决性别角色期望、性伙伴关系、性别权力、暴力以及发生饮酒和性风险行为的环境。目标3。在6个月和12个月的随访中，进行一项随机分组试验，比较综合干预（条件3：增强夫妻关系）与以性别为重点的干预（条件2：性别）和条件1：男性控制和女性合作对AOD使用、性风险行为和性别暴力的相对疗效。

DESCRIPTION (provided by applicant): Previous studies in South Africa have identified problem drinking, sexual risk, and gender-based violence as high prevalence interrelated behaviors. Research has shown that empowering interventions that increase self-efficacy through skills-building activities have reduced risky behavior. However, there is still a substantial gap in knowledge regarding how interventions might address the interrelationships of these risky behaviors between men and women and how these behaviors are influenced by environmental factors (e.g., place where people drink, violence in and around these drinking venues, and neighborhood characteristics). This suggests a need to test interventions that target patrons of drinking venues where these risk behaviors occur as well as conducting HIV prevention interventions in close proximity to these venues to challenge community behaviors. This proposal responds to this need by conducting a venue-based recruitment from drinking venues in randomized neighborhood blocks identified through geographic information systems (GIS) mapping to three study conditions. The proposed team of U.S. and South African investigators will build upon its initial studies to address these interrelated risk behaviors by first focusing on the environmental context and on refining the proposed interventions for the group randomized trial of neighborhoods to one of three intervention conditions in which individual assessments, HIV testing, and group interventions will be conducted in a mobile unit outside drinking venues. The three interventions are Condition 1-Men's Control Group and Women's CoOp; Condition 2-Men as Partners and Women's CoOp; and Condition 3-Men as Partners, Women's CoOp, and Couples' Sessions. Both the Women's CoOp and the couples are evidenced- based HIV interventions that have been adapted internationally. Men as Partners is conducted in South Africa, as well as worldwide. The specific aims of this proposal are: Aim 1. To characterize the types of drinking venues (e.g., licensure status and size), their immediate context (e.g., observed availability of other drugs, violence and sexual activity), and surrounding neighborhood characteristics (e.g., number of drinking venues) in the sampled neighborhood blocks in two large Black/African and Coloured communities in Cape Town, South Africa. Aim 2. To refine through qualitative methods the proposed interventions in relation to skills-building to address gender-role expectations, sexual partnering, gender power, violence, and environments where drinking and sexual risk behaviors occur. Aim 3. To conduct a randomized group trial to compare the relative efficacy of a comprehensive intervention (Condition 3: Enhanced Couples) to the gender-focused intervention (Condition 2: Gender) and to Condition 1: Men's Control and Women's CoOp on AOD use, sexual risk behavior, and gender-based violence at 6- and 12-month follow-ups. PUBLIC HEALTH RELEVANCE: Although there has been substantial focus on the HIV/AIDS epidemic in South Africa, particularly among at-risk women, less attention has been given to environmental factors that may promote risky behaviors and interfere with intervention efficacy, such as where one drinks and use of other drugs. Reaching men, who have much of the control over sexual decision-making, is essential in reducing HIV risk among women and men. It is time to merge successful, evidence-based interventions for both genders into an innovative and testable approach that considers sociocultural traditions, including AOD use, sexual partnerships, violence against women, and men's reluctance to use condoms; and environmental context (e.g. venues where drinking occurs, neighborhoods) to reach men to recruit couples to improve their resilience to these high risk neighborhoods and empower positive behavior change.