Protecting Women from Economic shocks to fight HIV in Africa (POWER)

艾滋病毒/艾滋病是全球死亡的主要原因之一，也是15-44岁妇女死亡的主要原因。15至24岁的非洲妇女感染艾滋病毒的可能性比同龄男子高一倍。喀麦隆是全球艾滋病毒性别差距最大的国家之一，在该国，少女感染艾滋病毒的可能性是同龄男孩的五倍。越来越多的研究表明，性交易和商业性行为中的风险-除了生物学上的易感性之外-是造成艾滋病毒/艾滋病方面两性不平等的原因。然而，人们对非洲从事这些性行为的妇女的危险性行为的主要原因缺乏了解。最近的研究表明，妇女采取危险性行为主要是为了科普收入方面的负面冲击（如农业和气候冲击、家庭成员生病或死亡），并表明经济冲击是非洲艾滋病毒难题的重要组成部分。如果妇女采取危险的性行为来科普收入的负面冲击，那么为妇女提供正式的风险应对战略可能是预防艾滋病毒的一个非常有希望的办法。然而，在知识方面仍然存在重要的差距，主要是因为以前没有研究专门回答这个研究问题。这项研究的目标是填补这些知识空白，以便为设计新的公共卫生干预措施提供信息，以应对性传播感染（STI）和艾滋病毒。具体而言，这项研究的目的是：（1）估计影响家庭的经济冲击对年轻妇女性行为和性传播感染和艾滋病毒感染的影响，（2）查明经济冲击影响性传播感染和艾滋病毒的渠道，（3）评估保护妇女免受经济冲击的干预措施的有效性，以预防性传播感染和艾滋病毒;（4）衡量成本-保护妇女免受经济冲击的干预措施的有效性，以预防一般人群中的艾滋病毒。拟议的研究将使用喀麦隆一个新的妇女群体的数据。该研究招募了1，500名从事性交易或商业性行为的未婚女性，包括三项生物行为和社会经济调查。一项随机对照试验被嵌入到队列研究中，并为分配到治疗组的妇女提供了正式的风险应对策略（家庭健康保险）。这项研究对于解决我们这个时代的一个重要公共卫生挑战是迫切需要的，并且有很大的潜力对制定艾滋病毒/艾滋病研究议程产生长期持久的影响。

HIV/AIDS is one of the leading cause of mortality globally and the leading cause among women aged 15-44 years. African women aged 15-24 are twice more likely to be infected with HIV than their male counterparts. In Cameroon, one of the countries with the highest gender disparity in HIV globally, adolescent girls are five times more likely to be infected with HIV than boys of the same age. There is a growing number of studies showing that risks taken during transactional sex and commercial sex -in addition to biological susceptibility- are responsible for gender inequalities in HIV/AIDS. However, there is superficial understanding of the main causes driving risky sexual behaviours of women who engage in those practises in Africa. Recent studies have shown that women mainly adopt risky sexual behaviours in order to cope with negative income shocks (e.g. agricultural and climatic shocks, illness or death of family members) and suggest that economic shocks are a substantial piece of the HIV puzzle in Africa. If women adopt risky sexual behaviours to cope with negative income shocks, hence providing women formal risk-coping strategies could be a very promising approach to prevent HIV. However, there are still important gaps in knowledge, mainly because no previous study has been designed to specifically answer this research question. The goal of this research is to fill these gaps in knowledge in order to inform the design of novel public health interventions to tackle sexually transmitted infections (STIs) and HIV. Specifically, the study aims (1) to estimate the effect of economic shocks affecting households on sexual behaviours and STI and HIV acquisition of young women, (2) to identify the channels through which economic shocks affect STIs and HIV, (3) to estimate the effectiveness of an intervention that protects women from economic shocks to prevent STI and HIV and (4) to measure the cost-effectiveness of an intervention that protects women from economic shocks to prevent HIV in the general population. The proposed study will use data from a new cohort of women in Cameroon. The study has recruited 1,500 unmarried women engaging in transactional sex or commercial sex, including three biobehavioural and socioeconomic surveys. A randomised controlled trial was embedded to the cohort study and has provided women allocated to the treatment group with a formal risk-coping strategy (a family health insurance). This research is of immediate necessity to address a vital public health challenge of our time and has the strong potential to have a long lasting impact on shaping the research agenda on HIV/AIDS.