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

描述(由申请者提供)：南非以前的研究发现，问题饮酒、性风险和基于性别的暴力是高流行率的相关行为。研究表明，通过技能建设活动提高自我效能感的赋权干预措施可以减少危险行为。然而，关于干预措施如何处理男性和女性之间这些危险行为的相互关系，以及这些行为如何受到环境因素(例如，人们饮酒的地点、饮酒场所及其周围的暴力行为和邻里特征)的影响，仍然存在很大的知识差距。这表明有必要测试针对这些危险行为发生的饮酒场所的顾客的干预措施，并在这些场所附近进行艾滋病毒预防干预，以挑战社区行为。这项建议回应了这一需求，通过地理信息系统(GIS)映射到三个研究条件，从随机社区街区的饮酒场所进行基于地点的招募。拟议的美国和南非调查团队将在其初步研究的基础上，首先专注于环境背景，并将社区团体随机试验的拟议干预措施细化为三种干预条件之一，在这三种干预条件中，个人评估、艾滋病毒检测和群体干预将在饮酒场所外的移动单元中进行。这三种干预措施是条件1--男性控制组和女性笼子；条件2-男性作为伴侣和女性笼子；以及条件3-男性作为伴侣、女性笼子和夫妻会话。妇女鸡舍和夫妇都是以证据为基础的艾滋病毒干预措施，已在国际上得到调整。男性作为合作伙伴在南非和世界各地进行。这项建议的具体目的是：目标1.在南非开普敦两个黑人/非洲人和有色人种社区的抽样社区中，确定饮酒场所的类型(例如，许可证状况和规模)、其直接背景(例如，观察到其他毒品的供应情况、暴力和性活动)以及周围社区特征(例如，饮酒场所的数量)。目的2.通过定性方法完善与技能建设有关的拟议干预措施，以解决性别角色期望、性伙伴关系、性别力量、暴力以及发生饮酒和性危险行为的环境。目的3.在6个月和12个月的随访中，进行随机分组试验，比较综合干预(条件3：强化夫妻)与以性别为重点的干预(条件2：性别)和条件1：男性控制和女性对AOD使用、性危险行为和基于性别的暴力的相对有效性。 与公共卫生相关：尽管人们对南非的艾滋病毒/艾滋病疫情，特别是高危妇女的艾滋病毒/艾滋病疫情给予了相当大的关注，但对可能促进危险行为并干扰干预效果的环境因素关注较少，例如在哪里饮酒和使用其他药物。接触男性，因为他们在很大程度上控制着性决策，对于降低女性和男性的艾滋病毒风险至关重要。现在是时候将针对两性的成功的循证干预措施融合到一种创新和可测试的方法中，该方法考虑到社会文化传统，包括AOD的使用、性伙伴关系、对妇女的暴力行为以及男性不愿使用避孕套；以及环境背景(例如饮酒场所、社区)，以接触到男性招募夫妇，以提高他们对这些高危社区的适应能力，并增强积极行为改变的能力。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Although there has been substantial focus on the HIV/AIDS epidemic in South Africa, particularly among at-risk women, less attention has been given to environmental factors that may promote risky behaviors and interfere with intervention efficacy, such as where one drinks and use of other drugs. Reaching men, who have much of the control over sexual decision-making, is essential in reducing HIV risk among women and men. It is time to merge successful, evidence-based interventions for both genders into an innovative and testable approach that considers sociocultural traditions, including AOD use, sexual partnerships, violence against women, and men's reluctance to use condoms; and environmental context (e.g. venues where drinking occurs, neighborhoods) to reach men to recruit couples to improve their resilience to these high risk neighborhoods and empower positive behavior change.