HIV/STI Prevention among Alcohol-Abusing Women in Mongolia

描述(由申请人提供)：需要有针对性、低成本、经验性验证的预防干预措施，以帮助防止艾滋病毒/性传播感染在资源贫乏社会的妇女中扩散。蒙古地处亚洲中部，与俄罗斯和中国接壤，这两个国家的艾滋病毒疫情正在迅速扩大。自1990年以来，蒙古经历了毁灭性的经济变化，导致36%以上的人口生活在贫困中，并迫使不成比例的妇女离开劳动力大军。缺乏就业导致寻求就业的男性在国内和国外移徙的增加，以及在边境和贸易路线沿线从事生存性工作的妇女人数大幅增加。这种移徙模式与无保护措施的性交换交易和艾滋病毒/性传播疾病的跨地域传播有关。伴随着危险异性行为机会的增加，酗酒和性传播感染(STI)的比例也在上升。在普通成年人中，88%的男性和58%的女性报告饮酒。由于文化上的否认和耻辱，女性中的酒精滥用在很大程度上被低估了，但对48名最近从事艾滋病毒/性传播感染性行为的女性进行的一项试点研究发现，85%的女性参与了有害的酒精使用。在25岁以下的女性中，高达58%的人至少诊断出一次性传播感染。强有力的证据表明，在性传播感染的情况下，无保护措施的性接触会增加艾滋病毒传播的可能性，饮酒与性风险的增加有关，这表明，如果没有迫切需要的干预措施，蒙古将成为中亚区域艾滋病毒流行的重要贡献者。创新的适应、引入和测试低成本、有针对性、经经验验证的预防干预措施可能有助于防止艾滋病毒在蒙古的上升。这项拟议的研究旨在实现以下主要目标：1)调整和结合4节HIV性行为风险降低干预(HIV-SRR)和2节动机访谈(ML)干预，并为蒙古从事高危性行为的酗酒妇女量身定做；2)通过对165名妇女进行三组随机临床试验(RCT)，对联合干预(HIV-SRR+MI)或单一时间匹配(HIV-SRR)降低风险干预或时间匹配健康促进(WP-C)条件下的HIV-SRR+MI在减少性行为危险行为方面的有效性进行初步估计；以及3)在目标人群中检查和增强未来更大规模RCT测试组合HIV-SRR+MI或单一成分HIV-SRR干预的有效性的可行性。蒙古乌兰巴托国家艾滋病基金会(NAF)项目的女性客户将被招募。研究评估将在基线、干预后立即以及3个月和6个月的随访中完成。这项研究将由哥伦比亚大学社会工作学院社会干预小组的Susan Witte博士和Nabila Ei-Bassel博士与NAF、蒙古国家传染病中心和精神健康和肿瘤学中心合作进行。

DESCRIPTION (provided by applicant): Targeted, low cost, empirically-validated prevention interventions are needed to help prevent the proliferation of HIV/STIs among women in resource poor societies. Centrally located in Asia, Mongolia is bordered by Russia and China: two countries experiencing rapidly expanding HIV epidemics. Since 1990, Mongolia has endured devastating economic changes leading to over 36% of the population living in poverty, and driving a disproportionate number of women out of the labor force. Lack of employment has resulted in increases in internal and external migration among men in search of employment and a great increase in the number of women engaging in survival sex work along borders and trade routes. Such migration patterns have been linked with unprotected sex exchange transactions and transmission of HIV/STIs across geographic boundaries. Concurrent with increasing opportunities for risky heterosexual behaviors are rising rates of alcoholism and sexually transmitted infections (STIs). In the general adult population, 88% of men and 58% of women report alcohol use. Alcohol abuse among women is largely underreported due to cultural denial and stigma, but a pilot study among 48 women engaging in recent HIV/STI sexual risk behaviors found that 85% were engaged in harmful alcohol use. Up to 58% of women under the age of 25 have at least one diagnosed STI. Strong evidence that unprotected sexual contact in the presence of STIs enhances the probability of HIV transmission and that alcohol use is associated with increased sexual risk suggests that, without urgently needed interventions, Mongolia is poised to become a significant contributor to the regional Central Asian HIV epidemic. Innovative adaptation, introduction and testing of low cost, targeted, empirically validated prevention interventions may help prevent the rise of HIV in Mongolia. The proposed study is designed to achieve the following primary aims: 1) to adapt and combine a 4- session HIV sexual risk reduction intervention (HIV-SRR) and a 2-session motivational interviewing (Ml) intervention and tailor them to alcohol-abusing women who engage in high risk sexual behaviors in Mongolia; 2) to obtain preliminary estimates for the efficacy of the combined intervention (HIV-SRR+MI) on reduction in sexual risk behaviors by conducting a 3-arm randomized clinical trial (RCT) with 165 women, assigned to either a combination (HIV-SRR+MI) or single, time-matched (HIV-SRR) risk reduction intervention or a time-matched wellness promotion (WP-C) condition; and 3) to examine and enhance the feasibility of a future, larger-scale RCT testing the efficacy of the combination HIV-SRR+MI or single component HIV-SRR only interventions among the target population. Women clientele of the National AIDS Foundation (NAF) program in Ulaanbaatar, Mongolia will be recruited. Study assessments will be completed at baseline, immediately post-intervention, and 3 and 6 month follow-up. In partnership with the NAF, the Mongolian National Center for Communicable Diseases and the Center of Mental Health and Narcology, the study will be conducted by Drs. Susan Witte and Dr. Nabila EI-Bassel of the Social Intervention Group at the Columbia University School of Social Work.