Venue-Based Recruitment and HIV Prevention for AOD Using Couples in South Africa

项目总结/摘要 南非先前的研究已经确定了问题饮酒，性风险和基于性别的暴力 高流行率的相关行为。研究表明，增强干预能力， 通过技能建设活动提高自我效能感，减少了危险行为。然而，仍然有大量的 关于干预措施如何解决这些危险行为的相互关系的知识缺口 以及这些行为如何受到环境因素的影响（例如，地方 人们在哪里喝酒，这些饮酒场所内和周围的暴力，以及社区特征）。这 建议有必要测试干预措施，目标是发生这些危险行为的饮酒场所的顾客 以及在这些场所附近进行艾滋病毒预防干预， 社区行为。这项提议是为了满足这一需要， 通过地理信息系统（GIS）确定的随机邻近街区的饮酒场所 映射到三个研究条件。拟议中的美国和南非调查小组将建立 在其初步研究，以解决这些相互关联的风险行为，首先侧重于环境 的背景下，并完善了拟议的干预措施，为小组随机试验的社区之一， 三个干预条件，其中个人评估，艾滋病毒检测和团体干预将 在饮酒场所外的一个移动的单位进行。三种干预措施是条件1-男子控制 条件2-男子作为伙伴，妇女作为合作伙伴;条件3-男子作为伙伴， 伙伴，妇女合作，和夫妇的会议。无论是女性的合作和夫妇证明- 艾滋病干预措施已在国际上得到调整。“男子作为伙伴”在南方进行 非洲，以及全世界。这项建议的具体目标是： 目标1.描述饮酒场所的类型（例如，许可证状态和规模），其直接背景 (e.g.,观察到的其他药物，暴力和性活动的可用性），以及周围的社区 特性（例如，饮酒场所的数量）在两个大的抽样街区 南非开普敦的黑人/非洲人和有色人种社区。 目标2.通过定性方法完善与技能建设有关的拟议干预措施， 解决性别角色的期望，性伙伴关系，性别权力，暴力，和环境， 饮酒和性风险行为的发生。 目标3.进行随机分组试验，比较综合干预的相对疗效 （条件3：加强夫妇）到以性别为重点的干预（条件2：性别）， 条件1：男性控制和女性CoOp对AOD使用，性风险行为和基于性别的 6个月和12个月随访时的暴力行为。

PROJECT SUMMARY/ABSTRACT Previous studies in South Africa have identified problem drinking, sexual risk, and gender-based violence as high prevalence interrelated behaviors. Research has shown that empowering interventions that increase self-efficacy through skills-building activities have reduced risky behavior. However, there is still a substantial gap in knowledge regarding how interventions might address the interrelationships of these risky behaviors between men and women and how these behaviors are influenced by environmental factors (e.g., place where people drink, violence in and around these drinking venues, and neighborhood characteristics). This suggests a need to test interventions that target patrons of drinking venues where these risk behaviors occur as well as conducting HIV prevention interventions in close proximity to these venues to challenge community behaviors. This proposal responds to this need by conducting a venue-based recruitment from drinking venues in randomized neighborhood blocks identified through geographic information systems (GIS) mapping to three study conditions. The proposed team of U.S. and South African investigators will build upon its initial studies to address these interrelated risk behaviors by first focusing on the environmental context and on refining the proposed interventions for the group randomized trial of neighborhoods to one of three intervention conditions in which individual assessments, HIV testing, and group interventions will be conducted in a mobile unit outside drinking venues. The three interventions are Condition 1-Men's Control Group and Women's CoOp; Condition 2-Men as Partners and Women's CoOp; and Condition 3-Men as Partners, Women's CoOp, and Couples' Sessions. Both the Women's CoOp and the couples are evidenced- based HIV interventions that have been adapted internationally. Men as Partners is conducted in South Africa, as well as worldwide. The specific aims of this proposal are: Aim 1. To characterize the types of drinking venues (e.g., licensure status and size), their immediate context (e.g., observed availability of other drugs, violence and sexual activity), and surrounding neighborhood characteristics (e.g., number of drinking venues) in the sampled neighborhood blocks in two large Black/African and Coloured communities in Cape Town, South Africa. Aim 2. To refine through qualitative methods the proposed interventions in relation to skills-building to address gender-role expectations, sexual partnering, gender power, violence, and environments where drinking and sexual risk behaviors occur. Aim 3. To conduct a randomized group trial to compare the relative efficacy of a comprehensive intervention (Condition 3: Enhanced Couples) to the gender-focused intervention (Condition 2: Gender) and to Condition 1: Men's Control and Women's CoOp on AOD use, sexual risk behavior, and gender-based violence at 6- and 12-month follow-ups.