Reducing Alcohol-related HIV/STI Risk for Women in Reproductive Health Clinics

描述（由申请人提供）：艾滋病毒和其他性传播感染（STIs）具有有害和昂贵的后果（即不孕症，癌症，艾滋病）。滥用酒精的年轻妇女特别容易感染艾滋病毒和其他性传播感染。单一重点干预措施（即主要关注性危险行为或酒精使用的干预措施）只能适度减少与酒精有关的性危险行为。缺乏针对亲密关系和性行为中酒精使用问题的综合、针对性别的干预措施。我们提出一项研究方案，以制定和试点测试一项减少酒精和性风险的综合干预措施，用于生殖健康和计划生育（RHFP）环境，在那里可以找到许多有风险的年轻妇女。首先，我们将招募约30名报告有酒精滥用和性传播感染风险的年轻女性（18-29岁），并进行6- 8个焦点小组（fg），以获取有关酒精使用和关系类型如何驱动性风险行为的信息。其次，利用从fg中获得的信息，我们将开发一个综合的、单独交付的简短干预（BI），利用已证实的策略（例如，个性化反馈、规范性比较、目标设定）来促进减少酒精和性风险。我们的目标是通过开发新的组件来提高集成BI的功效，这些组件(a)将性行为作为酒精中毒的原因和后果，(b)将伴侣类型作为酒精使用和性风险行为的上下文决定因素。第三，我们将对大约10名患者进行BI试点，以完善BI。第四，我们将开发一个用户友好的网站（使用以前开发和评估的材料），以(a)扩大BI的范围（即，通过促进行为技能的发展）和(b)促进维持初始干预收益（即，通过将BI扩展到自然环境中）。

DESCRIPTION (provided by applicant): HIV and other sexually transmitted infections (STIs) have harmful and costly consequences (i.e., infertility, cancer, AIDS). Young women who misuse alcohol are particularly vulnerable to HIV and other STIs. Single- focus interventions (i.e., those that focus primarily on sexual risk behavior or on alcohol use) result in only modest reductions in alcohol-related sexual risk behavior. Lacking are integrated, gender-tailored interventions that address alcohol use in the context of intimate relationships and sexual behavior. We propose a program of research to develop and pilot test an integrated alcohol and sexual risk reduction intervention for use in reproductive health and family planning (RHFP) settings where many young at-risk women can be found. First, we will recruit ~30 young women (18-29 years old) who report risk for alcohol misuse and STIs, and conduct 6- 8 focus groups (FGs) to elicit information regarding how alcohol use and relationship type drive sexual risk behavior. Second, using information obtained from the FGs, we will develop an integrated, individually- delivered Brief Intervention (BI) that draws upon proven strategies (e.g., personalized feedback, normative comparisons, goal setting) to promote alcohol and sexual risk reduction. We aim to enhance the efficacy of the integrated BI by developing novel components that (a) address sexual behavior as both a cause and consequence of alcohol intoxication and (b) address partner type as a contextual determinant of both alcohol use and sexual risk behavior. Third, we will pilot test the BI with ~10 patients to refine the BI. Fourth, we will deveop a user-friendly website (using previously developed and evaluated materials) that (a) broadens the scope of the BI (i.e., by promoting behavioral skills development) and (b) promotes maintenance of initial intervention gains (i.e., by extending the BI into the natural environment). Finally, we will conduct a pilot trial to evaluate the feasibility and acceptability of both the BIand the website, and obtain initial evidence of their efficacy. For the pilot trial, 50 at-risk young women will be recruited and asked to (a) complete a baseline assessment, (b) be randomized to either the clinic-based BI (supplemented by mobile messages that encourage them to view the extender website) or a control condition, and (c) return for a three-month follow-up. At both baseline and follow-up, we will measure alcohol use and sexual risk behavior as well as hypothesized mediators of behavior change. The proposed research, which builds on and integrates the investigators' expertise in sexual risk reduction and alcohol use intervention development, provides a preliminary pilot test of the BI, and will also allow us to pilot assessments, interventions, and procedures to prepare for a fully- powered, R01-supported, randomized controlled trial testing longer-term effects of the integrated alcohol and sexual risk reduction intervention. If successful, this research will lead to an efficacious BI that can be disseminated to sexual health clinics across the nation, and thereby reduce the incidence of HIV, STIs, harmful alcohol use, and related health consequences in young women.