Venue-based HIV and alcohol use risk reduction among female sex workers in China

中国女性性工作者的场所艾滋病毒和饮酒风险降低

• 批准号: 7694372
• 负责人: Xiaoming Li
• 金额: $ 55.15万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-25 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7694372
• 关键词: AIDS/HIV problem; Address; Adolescent; Africa; Alcohol abuse; Alcohol consumption; Alcoholic Intoxication; Alcohols; Asia; Asians; Attitude; Behavioral; Belief; Biological Markers; Characteristics; China; Cities; Client; Communication; Communities; Complex; Counseling; Country; Data; Developed Countries; Developing Countries; Development; Educational Curriculum; Environmental Risk Factor; Epidemic; Evaluation; Event; Evidence based program; Expectancy; Female; Gatekeeping; HIV; HIV/STD; Individual; Infection; Institutional Policy; International; Intervention; Interview; Knowledge; Literature; Mediating; Mediation; Modification; Outcome Measure; Pattern; Personal Attribute; Persons; Phase; Policies; Population; Process; Program Development; Program Evaluation; Prostitution; Protocols documentation; Randomized; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Risk; Risk Behaviors; Risk Reduction; Role; Sampling; Sex Behavior; Statutes and Laws; Testing; Training; base; behavior change; cohort; condoms; consistent condom use; experience; follow-up; high risk; improved; intervention program; programs; public health relevance; sex; sex risk; skills; skills training; social; social cognitive theory; success; theories; tool; transmission process; young adult

DESCRIPTION (provided by applicant): The global literature indicates an important role of alcohol use in facilitating HIV/AIDS transmission risk in commercial sex venues where elevated alcohol use/abuse and sexual risk behaviors frequently co-occur. Because the relationship between alcohol use and sexual risk behaviors in commercial sex venues results not only from individual attributes (personal knowledge, attitudes, and skills), but also from complex interactions among individual, relational, situational, and social environmental factors, there is a need for intervention approaches that extend beyond the individual level and address structural or community level factors. Although structural-level changes (e.g., legislation, governmental policy) regarding commercial sex have demonstrated considerable success in effecting sustainable risk reduction among female sex workers (FSWs) and their clients in several nations, the introduction of such changes remains challenging in many nations including China. In these later countries, local-level, establishment-based approaches may be needed to curtain the interrelated epidemics of alcohol use and HIV/STD among this high risk population before broader structural changes become feasible. Previous studies in Asia and Africa and our own data from FSWs in China suggest that the social norms and institutional policy within commercial sex venues as well as agents overseeing the FSWs (i.e., the "gatekeepers", defined as persons who manage the establishments and/or sex workers) are potentially of great importance in influencing alcohol use and sexual behavior among establishment-based FSWs. Therefore, in this application, we propose to develop, implement, and evaluate a venue- based alcohol use and HIV risk reduction intervention focusing on both environmental and individual factors among venue-based FSWs in China. The proposed venue-based intervention consists of three components: (1) gatekeeper training with a focus on changing or enhancing the protective social norms and policy/practice at the establishment level; (2) FSW training with a focus on the acquisition of communication skills (negotiating, limit setting) and behavioral skills (e.g., condom use skills, consistent condom use); and (3) semi-annual boosters to reinforce both social norms within establishments and individual skills. The efficacy of the venue-based intervention will be evaluated through a community-based cluster randomized controlled trial among 100 commercial sex venues in Beihai, a costal tourist city in Guangxi, China. We anticipate that the venue-based intervention program will be culturally appropriate, feasible, effective and sustainable in alcohol use and sexual risk reduction among FSWs. We hypothesize that the venue-based intervention will change and enhance the protective social norms and institutional policies at the establishment level and such enhancement, accompanied by individual skill training among FSWs, will demonstrate a sustainable effect within commercial sex establishments in decreasing problem drinking and alcohol-related sexual risk, increasing consistent and correct condom use, and reducing rates of HIV/STD infection among FSWs. PUBLIC HEALTH RELEVANCE: We propose a 5-year study to develop, implement, and evaluate a theory-guided, multiple components, and venue-based HIV and alcohol use risk reduction intervention among commercial sex workers (FSWs) in China. There are three main operational phases in this study. Phase One involves formative research to collect additional data regarding alcohol use/abuse and related sexual risk among FSWs in China through both rapid quantitative assessment and in-depth qualitative inquiries. These data will be supplementary to the existing data on sexual risk among FSWs we collected in our previous study among FSWs in China. Phase Two will focus on further modification, pilot-testing, and finalization of both the proposed intervention curricula and assessment tools. The proposed intervention program will be a cultural adaptation and integration of existing evidence-based programs in Asian settings. The additional modification efforts will be informed by the data we collected in Phase One. Phase Three includes the intervention delivery and evaluation through a venue-based cluster randomized controlled trial among 100 commercial sex venues (with about 150 gatekeepers and an open cohort of 700 FSWs) in Beihai, a coastal tourist city in Guangxi China. Serial behavioral and biomedical data from both gatekeepers and FSWs will be collected every 6 months over a 2-year period to assess the long-term impact of the intervention.

描述（由申请人提供）：全球文献表明，酒精使用在促进艾滋病毒/艾滋病传播风险中的重要作用在商业性别场所的传播风险升高，在这种情况下，酒精使用/滥用和性风险行为经常同时发生。因为商业性爱场所中酒精使用与性风险行为之间的关系不仅是由于个人属性（个人知识，态度和技能），而且还来自个人，关系，情境和社会环境因素之间的复杂相互作用，因此需要采取干预方法扩展到超越个体水平和解决结构或社区水平的因素。尽管有关商业性别的结构性变化（例如，立法，政府政策）在影响女性性工作者（FSWS）及其客户的可持续风险降低方面取得了很大的成功，但在包括中国在内的许多国家，引入此类变化仍然具有挑战性。在这些后来的国家中，可能需要采用本地级别的基于机构的方法，以在这种高风险人群中掩盖相互关联的饮酒和艾滋病毒/性病的流行，然后再进行更广泛的结构变化。以前在亚洲和非洲的研究以及我们来自中国FSW的数据表明，商业性爱场所内的社会规范和机构政策以及监督FSWS的代理商（即，被定义为管理机构和性别工作者的人的“守门员”）在影响基于饮酒和性行为的FSW的机构中非常重要。因此，在此应用程序中，我们建议在中国的基于基于环境的FSW中开发，实施和评估基于场地的酒精使用和降低艾滋病毒风险干预措施。拟议的基于场地的干预措施包括三个组成部分：（1）守门员培训，重点是在机构层面改变或增强保护性的社会规范和政策/实践； （2）FSW培训的重点是掌握沟通技巧（谈判，限制设置）和行为技能（例如，使用避孕套技能，一致的避孕套使用）； （3）半年度助推器，以加强机构和个人技能中的社会规范。基于场地干预的功效将通过基于社区的集群随机对照试验进行评估，该试验是中国广西的哥斯尔旅游城市Beihai的100个商业性爱场所。我们预计，基于场地的干预计划将在文化上适当，可行，有效和可持续性，可在FSW中饮酒和性风险降低。我们假设基于场地的干预措施将在建立水平上改变并增强保护性的社会规范和机构政策，并且这种增强伴随着FSW中的个人技能培训，将证明商业性生活中的可持续效果在减少问题的饮酒和酒精性性风险和与酒精相关的性风险和良好性使用中的持续性和正确使用率和降低HIV/STECT中的速度降低。 公共卫生相关性：我们提出了一项为期5年的研究，以开发，实施和评估中国商业性工作者（FSW）中基于地点的艾滋病毒和基于场地的艾滋病毒和饮酒风险干预措施。这项研究中有三个主要的操作阶段。第一阶段涉及形成性研究，以通过快速的定量评估和深入的定性查询来收集中国FSW中有关酒精使用/滥用和相关性风险的其他数据。这些数据将补充我们在中国FSW中研究中收集的FSW中有关性风险的现有数据。第二阶段将着重于进一步的修改，试点测试以及拟议的干预课程和评估工具的最终确定。拟议的干预计划将是在亚洲环境中现有基于证据的计划的文化适应和整合。我们在第一阶段收集的数据将告知额外的修改工作。第三阶段包括通过基于场地的集群随机对照试验进行干预交付和评估，该试验（约有150个守门人和一个公开的700 FSW的公开群体），位于中国的沿海旅游城市Beihai。来自看门人和FSW的串行行为和生物医学数据将在2年内每6个月收集一次，以评估干预措施的长期影响。