Preventing HIV Risk Among Adolescent Orphans in Kenya

说明（由申请人提供）：艾滋病大流行在受影响严重的国家导致数百万成年人患病和死亡，并造成数百万孤儿。在世界范围内，因艾滋病失去父母一方或双方的18岁以下儿童人数超过1500万，估计到2010年这一数字将超过2500万。这些儿童中的绝大多数——1100万——生活在撒哈拉以南非洲。随着孤儿进入青春期，他们更有可能变得性活跃，使他们自己面临通过性接触感染艾滋病毒/艾滋病的风险。本研究将把一项综合干预（"Reach Out"）扩展到邻近社区，并测试除了提供食物、安全饮用水和卫生保健外，对青少年孤儿继续上学的结构性支持是否能预防艾滋病毒风险行为。研究对象是肯尼亚尼扬扎省的罗族。卢奥族的艾滋病毒/艾滋病感染率为22%，是肯尼亚全国的3倍。本研究的具体目的如下：1)采用实验设计，将Reach Out干预扩展到邻近社区，测试学校支持元素是否延迟性首次行为和预防性风险行为；2)对Reach Out的延伸进行工艺评估，并准备一份手册以供进一步测试和复制。为了测试学校部分对艾滋病预防的影响，100名13-14岁的孤儿将被随机分为干预组和对照组。干预组将接受完整的Reach Out模式；对照组将获得食物和其他基本需求，但不包括学校支持。学生将回答一项自我管理的纵向调查（目标1）；Reach Out工作人员和其他社区线人将对定性访谈做出回应（目标2）。研究活动将由美国和肯尼亚的合作者共同进行。这项试点研究将为在肯尼亚和撒哈拉以南非洲其他地区的孤儿中预防艾滋病毒的“伸出援手”模式进行更大规模的复制和实验测试提供坚实的基础。

DESCRIPTION (provided by applicant): The AIDS pandemic has led to the illness and deaths of millions of adults in severely-affected countries, and has also led to millions of orphans. Worldwide, the number of children under age 18 who have lost one or both parents to AIDS stands at more than 15 million, and estimates are that this number will surpass 25 million by 2010. The vast majority - 11 million-of these children live in sub-Saharan Africa. As orphans reach puberty, they are more likely to become sexually active, placing them at risk of contracting HIV/AIDS themselves through sexual contact. This study will extend a comprehensive intervention ("Reach Out") to a neighboring community and test whether structural support for young adolescent orphans to continue school prevents HIV risk behaviors, over and above the provision of food, safe water, and health care. The study population is the Luo ethnic group in Nyanza Province, Kenya. The prevalence of HIV/AIDS among the Luo is 22%, 3 times higher than in Kenya as a whole. Specific aims for the proposed study are as follows: 1) To extend the Reach Out intervention to a neighboring community and test whether the school support elements delay sexual debut and prevent sexual risk behaviors, using an experimental design; and 2) To conduct a process evaluation of the extension of Reach Out and prepare a manual for further testing and replication. In order to test the effects of the school component on HIV prevention, 100 orphans, aged 13-14, will be randomized to intervention and control groups. The intervention group will receive the full Reach Out model; the control group will receive food and other basic needs, but not school support. Students will respond to a self administered longitudinal survey (Aim 1); Reach Out staff and other community informants will respond to qualitative interviews (Aim 2). Research activities will be jointly conducted by U.S. and Kenyan collaborators. The pilot study will provide a strong foundation for a larger replication and experimental testing of the Reach Out model for the prevention of HIV among orphans in other areas of Kenya and sub-Saharan Africa.