The Prevention of HIV/STI among Married Women in Urban India

描述（由申请人提供）：本提案旨在制定和评估一种文化上适当的、基于卫生设施的干预措施，以促进印度孟买（Bombay）经济边缘社区18-40岁已婚妇女对艾滋病毒和其他性传播感染（艾滋病毒/性传播感染）的初级预防。该提案回应了需要制定有效办法，以应对丈夫向妻子传播艾滋病毒/性传播感染的全球风险。这个拟议的项目采用了一种降低已婚妇女艾滋病毒/性传播感染风险的方法，其重点是妇女更愿意讨论和提出治疗的基于文化的妇科和相关健康症状。该提案的具体目标是：(1)对参与妇女保健的利益攸关方和机构进行形成性研究，包括家庭中的妇女、作为病人的妇女、丈夫及其与妻子健康的关系，以及社区中妇女保健的性质；(2)根据形成性研究，在现有公共卫生设施中制定和实施加强护理和夫妻干预，以减少妇女在婚姻内感染艾滋病毒/性传播感染的风险；(3)通过随机临床试验（RCT）检验干预措施的有效性，以降低艾滋病毒/性传播感染的风险，减少性传播感染和妇女妇科及相关症状，改善妇女的生活状况。拟议中的项目将在孟买的一个城市“贫民窟”社区进行。该项目将分为三个阶段：第一阶段（第一年）将涉及对保健和其他服务提供者、已婚妇女和已婚夫妇的形成性研究；这些数据的分析；最后完成干预设计。第二阶段（2-4年）涉及建立随机实验设计，包括：强化护理加夫妻干预；仅加强护理；护理标准加夫妻干预；和护理标准；第三阶段（2-5年级）将评估干预措施对已婚妇女的影响。世界上绝大多数妇女暴露于艾滋病毒/性传播感染的风险不是通过她们自己的机构，而是因为她们配偶的行为。这项研究的目的是制定一种方法，减少这些社区中弱势已婚妇女的风险，从而为印度以及其他发展中国家和发达国家的弱势妇女提供一个模式。

DESCRIPTION (provided by applicant): This proposal seeks to develop and evaluate a culturally appropriate, health facility-based intervention to promote primary prevention of HIV and other sexually transmitted infections (HIV/STIs) among married women, ages 18-40, living in an economically marginal community in Mumbai (Bombay), India. The proposal responds to the need to develop effective approaches to the global risk of husband to wife transmission of HIV/STIs. This proposed project utilizes an approach to HIV/STI risk reduction among married women that centers on culturally-based gynecological and related health symptoms that women feel more comfortable discussing and presenting for treatment. The specific aims of this proposal are to: (1) Conduct formative research on the stakeholders and institutions involved in women's health including women in the context of the family, women as patients, husbands and their relationship to the health of their wives, and the nature of health care for women in the community; (2) Develop and implement, based on the formative research, Enhanced Care and Couples' Intervention in an existing public health facility to reduce women's HIV/STI risk within marriage; (3) Test the efficacy of the interventions, through a randomized clinical trial (RCT), to reduce the risk of HIV/STI transmission, to reduce STIs and women's gynecological and related symptoms and to improve women's life situation. The proposed project will be conducted in an urban "slum" community of Mumbai. The project will be organized into three phases: Phase I (Year 1) will involve formative research on health and other service providers, married women, and married couples; analysis of these data; and finalization of the intervention design. Phase II (Years 2-4) involves the establishment of a randomized experimental design that will include: Enhanced Care plus Couples' Intervention; Enhanced Care Only; Standard of Care plus Couples' Intervention; and Standard of Care only; and Phase III (Year 2-5) will evaluate the impact of the interventions on married women. The great majority of women in the world are exposed to HIV/STI risk not through their own agency, but because of the behavior of their spouses. The intent of this study is to develop an approach that will reduce risk among vulnerable married women in these communities and thus serve as a model for India as well as for other vulnerable women in developing and developed countries.