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

描述（由申请人提供）：南非以前的研究已经确定问题饮酒，性风险和基于性别的暴力是高流行率的相互关联的行为。研究表明，通过技能建设活动提高自我效能的授权干预措施减少了危险行为。然而，关于干预措施如何解决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的影响（例如，人们喝酒的地方，这些喝酒场所内和周围的暴力，以及邻里特征）。这表明有必要测试针对发生这些风险行为的饮酒场所的顾客的干预措施，以及在这些场所附近进行艾滋病毒预防干预措施，以挑战社区行为。该提案响应了这一需求，通过地理信息系统（GIS）映射到三个研究条件，从随机化的街区中的饮酒场所进行基于场所的招募。美国和南非的研究人员将在其初步研究的基础上，首先关注环境背景，并将社区群体随机试验的拟议干预措施细化为三种干预条件之一，其中个人评估，HIV检测和群体干预将在饮酒场所外的移动的单位中进行。这三种干预措施是条件1-男子对照组和妇女合作;条件2-男子作为伙伴和妇女合作;条件3-男子作为伙伴、妇女合作和夫妇会议。妇女合作社和夫妻合作社都是基于证据的艾滋病毒干预措施，已在国际上进行了调整。“男子作为伙伴”在南非和全世界开展。本提案的具体目标是：目标1。描述饮酒场所的类型（例如，许可证状态和大小），它们的直接上下文（例如，观察到的其他药物、暴力和性活动的可用性），以及周围的邻里特征（例如，在南非开普敦的两个大的黑人/非洲人和有色人社区的抽样街区中，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，以解决性别角色期望、性伙伴关系、性别权力、暴力以及饮酒和性风险行为发生的环境。目标3。进行一项随机分组试验，以比较综合干预（条件3：增强夫妇）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CoOp在6个月和12个月随访时对AOD使用，性风险行为和基于性别的暴力的相对有效性。 公共卫生相关性：虽然南非的艾滋病毒/艾滋病流行病，特别是高危妇女的艾滋病毒/艾滋病流行病得到了大量关注，但对可能促进危险行为和干扰干预效果的环境因素，如饮酒和使用其他药物的环境因素，关注较少。男子对性决策有很大的控制权，因此接触男子对于减少妇女和男子的艾滋病毒风险至关重要。现在是将成功的、基于证据的两性干预措施纳入一种创新和可检验的办法的时候了，这种办法考虑到社会文化传统，包括使用避孕套、性伙伴关系、暴力侵害妇女行为和男子不愿使用避孕套;和环境背景（例如，发生饮酒的场所，社区），以达到男子招募夫妇，以提高他们的弹性，这些高风险的社区和授权积极的行为改变。

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.