MASLIHAT Intervention for Tajik Male Migrants Who Inject Drugs

项目总结 劳动力流动是助长全球艾滋病流行和艾滋病毒流动的主要因素 跨越国界和人口。在东道国注射毒品的移民尤其 风险很高。塔吉克斯坦是中亚的一个小国，每年出口100多万塔吉克斯坦人，其中许多人 注射毒品，暂时在自己的国家以外工作。我们早些时候对塔吉克劳工移民的研究 莫斯科表明，由于危险的药物使用，他们在规范和行为上对艾滋病毒的风险高得惊人， 共用针头，饮酒，与临时或有偿的性伴侣发生不安全的性行为。帮助遏制 在这一弱势人群中传播，我们开发并试点测试了“外来务工人员接近自我” 塔吉克人艾滋病毒/艾滋病学习干预“(MASLIHAT)预防模式。该模式招募和培训 注射毒品的现任和前任塔吉克移民在向他人传递干预措施时作为“同伴教育者” 在他们的社交网络中，同时降低自己的风险。MASLIHAT干预和我们的 研究工作建立在三个理论模型的基础上：社会-认知-行为理论，社会网络 理论和杨氏的迁徙理论。该模式本身在文化上适应了成功的盾牌模式，该模式 是美国疾病控制与预防中心指定的基于证据的最佳实践干预措施，用于塔吉克劳工移民 注射毒品的俄罗斯人。这项研究将测试MASLIHAT干预对对照的有效性 在会话次数、持续时间和兴趣方面与干预条件相同的状态 水平。我们将在5到9个塔吉克人小组的5次会议上提供MASLIHAT和控制组干预 注射毒品的男性流动人口为每组共10人进行干预。同行教育者将分享 他们在社交网络中与其他人一起了解到的情况，包括给谁注射毒品的两名网络成员 他们招募了参加这项研究的人。我们将评估MASLIHAT和控制参与者及其塔吉克人 男性社交网络成员在基线和干预后3、6、9和12个月。我们将进行 使用随机截获的混合效应模型进行重复测量线性和Logistic回归 测试：(1)如果HIV危险行为、预防自我效能和行为规范发生较大变化 MASLIHAT参与者(同伴教育者)与对照参与者进行比较，以及(2)如果艾滋病毒发生更大变化 同伴教育者网络成员的危险行为、预防自我效能和行为规范 与对照组网络成员进行比较。通过改变自己的危险行为，鼓励他人 这样做也有风险，外来同龄人教育者可以在个人和社会上发起积极的变化 当他们返回时，他们在东道国和母国的网络水平都很高。经济衰退带来的影响 拟议的研究在于开发一种亟需的、经过科学测试的干预措施，以减少艾滋病毒 在国内和跨国注射毒品的移民之间传播。

PROJECT SUMMARY Labor migration is a major contributor to fueling the global AIDS epidemic and also the movement of HIV across country borders and populations. Migrants who inject drugs while in a host country are at especially high risk. Tajikistan, a small country in Central Asia, exports more than a million Tajiks annually, many of whom inject drugs, to work temporarily outside of their own country. Our earlier research on Tajik labor migrants in Moscow showed them to be at alarmingly high normative and behavioral risk for HIV due to risky drug use, needle sharing, alcohol consumption, and unsafe sex with casual and paid sex partners. To help curb transmission in this vulnerable population, we developed and pilot tested the "Migrants' Approached Self- Learning Intervention in HIV/AIDS for Tajiks" (MASLIHAT) prevention model. The model recruits and trains current and former Tajik migrants who inject drugs as "peer educators" in delivering the intervention to others in their social networks while simultaneously reducing their own risk. The MASLIHAT Intervention and our research efforts build synergistically on 3 theoretical models: social-cognitive-behavioral theory, social network theory and Yang's Theory of Migration. The model itself culturally adapts the successful SHIELD model, which is a CDC- designated evidence-based best practice intervention in the U.S., for use with Tajik labor migrants in Russia who inject drugs. This study will test the efficacy of the MASLIHAT intervention against a control condition designed to be equal to the intervention condition in the number of sessions, duration, and interest level. We will deliver MASLIHAT and control group interventions over 5 sessions with groups of 5 to 9 Tajik male migrants who inject drugs for a total of 10 groups for each intervention. The peer educators will share what they learned with others in their social networks, including the 2 network members who inject drugs whom they recruited for enrollment in the study. We will assess MASLIHAT and control participants and their Tajik male social network members at baseline and at 3, 6, 9 and 12 months post-intervention. We will conduct repeated measures linear and logistic regressions using mixed effect models with random person intercepts to test: (1) if greater changes in HIV risk behaviors, prevention self-efficacy, and behavioral norms occur among MASLIHAT participants (peer educators) compared to control participants, and (2) if greater changes in HIV risk behaviors, prevention self-efficacy, and behavioral norms occur among peer educator network members compared to control group network members. By transforming their own risk behavior, and encouraging others at risk to do so as well, migrant peer educators can initiate positive changes at the individual and social network levels in both their host country and also their home country when they return. The impact of the proposed study lies in the development of a much needed scientifically tested intervention that reduces HIV transmission among migrants who inject drugs within and across country borders.