A structural HIV prevention intervention targeting high-risk women

针对高危女性的结构性艾滋病毒预防干预措施

• 批准号: 9136316
• 负责人: Susan G. Sherman
• 金额: $ 73.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9136316
• 关键词: AIDS prevention; Address; Area; Baltimore; Behavioral; Biological; Caring; Communities; Complex; Cost Measures; Counseling; Crack Cocaine; Cross-Sectional Studies; Dancing; Data; Distant; Drug usage; Education; Effectiveness; Enrollment; Environment; Epidemic; Exposure to; Funding; Goals; HIV; HIV Infections; HIV risk; HIV/STD; High Risk Woman; Homelessness; Hotlines; Hour; Housing; Human immunodeficiency virus test; Incidence; Infection; Intervention; Interview; Lead; Legal; Link; Location; Maryland; Measures; Mediator of activation protein; Medical; National Institute of Drug Abuse; Nature; Occupational activity of managing finances; Opioid; Outcome Study; Participant; Pharmacotherapy; Population; Poverty; Prevention approach; Preventive Intervention; Primary Health Care; Recruitment Activity; Reporting; Reproductive Health; Research; Risk; Risk Behaviors; Risk Reduction; Role; Sampling; Services; Sex Behavior; Statistical Data Interpretation; Testing; Time; Training; Unsafe Sex; Visit; Work; base; behavioral health; behavioral outcome; cocaine use; cohesion; cohort; collaborative environment; comparison group; cost; design; empowerment; experience; female sex worker; financial literacy; follow-up; geographically distant; high risk; implementation research; innovation; intervention effect; intimate partner violence; member; multidisciplinary; outreach; peer; programs; public health relevance; sex; skills; social; social stigma; systematic review; theories; therapy development

 DESCRIPTION (provided by applicant): Three decades into the HIV epidemic, high HIV/STI rates persist among FSWs throughout the world, and research on this population in the U.S. is scarce. FSWs experience a unique set of vulnerabilities associated with structural factors such stigma, and unsafe work environments. These factors inhibit protective sexual behaviors and seeking of HIV testing, care, and treatment. HIV prevention approaches that address social and structural vulnerabilities to HIV infection among FSWs have demonstrated effectiveness worldwide. We aim to develop and evaluate the effectiveness of a community-based combination HIV prevention package to include a range of biomedical, behavioral, and structural services, provided through the "STILETTO" Center. Trained peer educators (N=20) will conduct outreach in exotic dance club and street venues, promote the use of the Center, and enact community mobilization. The study's overall goal is to stimulate community empowerment, through such mechanisms as social cohesion and collective action, resulting in sustainable HIV risk reduction. We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer education, will lead to community empowerment and reduce HIV/STIs incidence and risk. The study aims to: 1) examine the effects of the intervention on FSWs' HIV risk behaviors (drug use/unprotected sex), and HIV/STI cumulative incidence over 18 months in the intervention (n=200) compared to those in the comparison (N=150) communities, and how these changes are associated with intervention exposure; 2) examine how socio-structural (e.g., social cohesion, stigma) and structural vulnerability indicators (e.g., financial and housing stability) change and are associated with the biological and behavioral outcomes over time in intervention (n=200) versus comparison (n=150) participants; and to 3) examine the intervention's implementation through qualitative (e.g., in-depth interviews) and quantitative (e.g., assessment of program fit, reach, facilitators and barriers, and program costs) measures. To achieve these aims, we propose developing and evaluating a theoretically informed, community-based comprehensive intervention comprised of the STILETTO Center, training FSW peer educators (N=20), and a 24-hour crisis hotline line. Our extensive community partners will provide services at the Center, thereby increasing sustainability. The study is innovative in its comprehensive approach targeting U.S. FSWs and addresses the growing call for designing and evaluating structural interventions, a NIDA priority (PA-12-281).