HIV Intervention among Women at High Risk

描述（由申请人提供）：本研究是一项在高危女性中进行的同行领导的多层次和多组分HIV干预的随机分组对照试验。主要目标是：（1）设计和实施一种将个人认知和社会影响方法与同伴教育相结合的艾滋病毒干预;（2）评估这种行为干预的效果;（3）确定艾滋病毒危险行为和行为改变的重要中介或调节因素。据估计，到2003年，中国将有84万人感染艾滋病毒，因此需要共同努力，在中国防治艾滋病流行病。这一流行病有可能通过性传播迅速蔓延到一般民众，这突出表明迫切需要在目标人群中采取更有效和可持续的艾滋病毒干预措施，因为这些人群感染艾滋病毒的风险很高，是艾滋病毒性传播的一个重要来源。然而，在中国，针对艾滋病毒高危妇女的干预措施很少。该研究的中心假设是，鉴于目标人群的边缘社会经济地位，艾滋病毒信息是必要的，但不足以改变行为;他们需要有动力采取保护行动，相信他们有能力和技能来管理困难的情况，并在社会和工作环境中赋予艾滋病毒行为改变的权力。艾滋病毒的干预措施将是最有效的，如果在小组会议提供的同龄人和参加的认知和社会过程的行为变化和文化和性别的适当性。这种有效改变艾滋病毒行为的概念将在大约712名从事娱乐业的妇女中进行测试和评估。参与者将以整群随机抽样方式选出，其中整群为娱乐场所。将从抽样机构中招募所有符合条件的妇女，并将同等数量的妇女分配到干预或控制条件下。这两组人都将接受标准的自愿咨询和检测（VCT）。但是，干预小组将接受由受过培训的同伴教育者提供的额外的激励和针对性别的赋权技能培训，并通过同伴外联和机构业主之间的结构性干预组成部分予以加强，以促进有利于减少艾滋病毒风险的有利的社会、规范和工作环境。通过评估干预组和对照组在干预后3个月、6个月和12个月自我报告的艾滋病毒风险和预防行为以及新发现的性传播感染，评估干预的有效性。研究结果将对中国高危妇女的有效预防干预产生深远的影响。中国的成功将反过来成为全球成功预防艾滋病毒传播的关键。

DESCRIPTION (provided by applicant): This study is a cluster-randomized controlled trial of a peer-led multilevel and multi-component HIV intervention among women at high risk. The main objectives are: (1) to design and implement an HIV intervention that combines individual cognitive and social influence approaches with peer education; (2) to evaluate the efficacy of such behavior intervention; and (3) to identify important mediating or moderating factors of HIV risk behavior and behavior change. With 840,000 people estimated to be infected with HIV by 2003, concerted efforts are needed to fight the AIDS epidemic in China. The danger that the epidemic can make a quick inroad to the general population through sexual transmission underscores the urgent need for more effective and sustainable HIV intervention among the target population, who are at high risk of acquiring HIV and a critical source of sexual transmission of HIV. However, few interventions have targeted women at high risk of HIV in China. The central hypothesis of the study is that, given the marginal socioeconomic status of the target population, HIV information is necessary but not sufficient for behavior change; they need to be motivated to take protective actions, be confident that they have the ability and skills to manage difficult situations, and in a social and working environment empowering of HIV behavior change. HIV intervention will be most effective if delivered in small group sessions by peers and attending to both cognitive and social processes of behavior change and cultural and gender appropriateness. This conceptualization of effective HIV behavior change will be tested and evaluated among about 712 women working in the entertainment industry. Participants will be selected through cluster-randomization sampling, in which the clusters are the entertainment establishments. All eligible women from the sampled establishments will be recruited and assigned with equal numbers to either an intervention or a control condition. Both groups will receive standard voluntary counseling and testing (VCT). But the intervention group will receive additional motivation enhancing and gender-specific empowerment skills trainings delivered by trained peer educators, augmented by peer outreach and a structural intervention component among owners of establishments to promote enabling social, normative, and working environments supportive of HIV risk reduction. The efficacy of the intervention will be evaluated through assessment of self-reported HIV risk and preventive behaviors and newly detected STIs at 3-, 6-, and 12-month post intervention between the intervention and the control groups. Findings will have far reaching implications for effective HIV prevention intervention among women at high risk in China. China's success will in turn be a key to global success in preventing the spread of HIV.