Evaluating a Microfinance Intervention for High Risk Women in Kazakhstan

描述（由申请人提供）：拟议的研究将检查艾滋病毒和小额信贷相结合的干预措施的有效性，以减少生物学证实的性传播感染（STI），艾滋病毒和丙型肝炎病毒的新发病率，以及在过去一年中注射毒品的520名妇女中报告的性和毒品风险行为，这些妇女在哈萨克斯坦的泰米尔陶和巴夫洛达尔从事性交易。哈萨克斯坦是过去十年来艾滋病毒感染率持续上升（>25%）的九个国家之一。贫穷等结构性力量以及吸毒者特别是妇女缺乏就业选择，使性交易成为一种生存策略，加剧了这一流行病。艾滋病毒预防科学家最近呼吁采取行动，强调需要对从事性工作同时也涉及毒品的妇女采取创新的结构性干预措施。拟议的研究建立在调查小组测试艾滋病毒预防和小额信贷干预相结合的R34的调查结果的基础上。在成功的方案和显著结果的基础上，我们将随机分配来自哈萨克斯坦泰米尔陶和巴夫洛达尔的520名注射毒品和从事性交易的妇女，接受（1）4次艾滋病毒预防干预和6次金融扫盲干预，参加现有的职业培训计划，并获得相应的储蓄（HIVRR+MF）;或单独进行4次HIV预防干预。艾滋病毒/艾滋病防治干预是以社会认知理论为指导的。HIVRR+MF干预将资产理论与社会认知理论相结合。小额信贷包括：1）金融知识; 2）职业培训; 3）小额储蓄，以支持过渡到更永久的就业地位。我们假设，增加金融知识，提高职业技能，以填补市场所需的职位，在当地经济，并开始个人储蓄计划，结合艾滋病毒的风险降低，将导致显着减少研究成果相比，没有小额信贷干预的HIVRR干预。如果调查结果很重要，则质量部分将审查促进或阻碍妇女参与小额供资干预并从中受益的因素，并进行成本和成本效益分析，以提供更多数据，为可推广的方案提供信息。 这项研究的结果不仅对中亚很重要，而且可能对美国和其他国家的公共卫生产生重要影响，这些国家的艾滋病毒/性传播感染和丙型肝炎病毒感染率仍然很高，从事性交易的吸毒妇女的就业率仍然很低。

DESCRIPTION (provided by applicant): The proposed study will examine the efficacy of a combined HIV and microfinance intervention to reduce biologically confirmed sexually transmitted infections (STIs), and new incidence of HIV and HCV, as well as reported sexual and drug risk behaviors among 520 women who have injected drugs in the past year and who engage in sex trading in Temirtau and Pavlodar, Kazakhstan. Kazakhstan is one of nine countries worldwide that has experienced a continuing rise in HIV infections (>25%) over the past decade. The epidemic is exacerbated by structural forces such as poverty and a lack of employment options for people who use drugs, especially women, which makes transactional sex a survival strategy. Recent calls for action by HIV prevention scientists have emphasized the need for innovative structural interventions for women engaged in sex work who are also drug-involved. The proposed study builds on findings from an R34 by the investigative team testing a combination HIV prevention and microfinance intervention. Building on successful protocols and significant results, we will randomly assign 520 women who inject drugs and engage in sex trading from Temirtau and Pavlodar, Kazakhstan to either (1) a 4 session HIV prevention intervention combined with a 6 session financial literacy intervention, enrollment in an existing vocational training program and receipt of matched savings (HIVRR+MF); or to the 4 session HIV prevention intervention alone. The HIVRR intervention is guided by social cognitive theory. The HIVRR+MF intervention integrates asset theory with social cognitive theory. The MF includes: 1) financial literacy; 2) vocational training; and 3) micro-savings to support transitionto a more permanent employment status. We hypothesize that increasing financial literacy, enhancing vocational skills required to fill marketable positions in the local economy, and beginning a personal savings program, combined with HIV risk reduction, will lead to significant reductions in study outcomes compared to an HIVRR intervention without a microfinance intervention. A qualitative component to examine factors that facilitate or impede women's ability to participate in and benefit from a microfinance intervention, and a cost and cost effectiveness analysis will provide additional data to inform a disseminable program if findings are significant. The findings from this study will be important not only for Central Asia, but may also have vital public health implications in the U.S. and other countries where HIV/STIs and HCV remain high and employment rates remain low among drug- involved women engaged in sex trading.