A structural HIV prevention intervention targeting high-risk women

针对高危女性的结构性艾滋病毒预防干预措施

• 批准号: 9136316
• 负责人: Susan G. Sherman
• 金额: $ 73.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9136316
• 关键词: AIDS prevention; Address; Area; Baltimore; Behavioral; Biological; Caring; Communities; Complex; Cost Measures; Counseling; Crack Cocaine; Cross-Sectional Studies; Dancing; Data; Distant; Drug usage; Education; Effectiveness; Enrollment; Environment; Epidemic; Exposure to; Funding; Goals; HIV; HIV Infections; HIV risk; HIV/STD; High Risk Woman; Homelessness; Hotlines; Hour; Housing; Human immunodeficiency virus test; Incidence; Infection; Intervention; Interview; Lead; Legal; Link; Location; Maryland; Measures; Mediator of activation protein; Medical; National Institute of Drug Abuse; Nature; Occupational activity of managing finances; Opioid; Outcome Study; Participant; Pharmacotherapy; Population; Poverty; Prevention approach; Preventive Intervention; Primary Health Care; Recruitment Activity; Reporting; Reproductive Health; Research; Risk; Risk Behaviors; Risk Reduction; Role; Sampling; Services; Sex Behavior; Statistical Data Interpretation; Testing; Time; Training; Unsafe Sex; Visit; Work; base; behavioral health; behavioral outcome; cocaine use; cohesion; cohort; collaborative environment; comparison group; cost; design; empowerment; experience; female sex worker; financial literacy; follow-up; geographically distant; high risk; implementation research; innovation; intervention effect; intimate partner violence; member; multidisciplinary; outreach; peer; programs; public health relevance; sex; skills; social; social stigma; systematic review; theories; therapy development

 DESCRIPTION (provided by applicant): Three decades into the HIV epidemic, high HIV/STI rates persist among FSWs throughout the world, and research on this population in the U.S. is scarce. FSWs experience a unique set of vulnerabilities associated with structural factors such stigma, and unsafe work environments. These factors inhibit protective sexual behaviors and seeking of HIV testing, care, and treatment. HIV prevention approaches that address social and structural vulnerabilities to HIV infection among FSWs have demonstrated effectiveness worldwide. We aim to develop and evaluate the effectiveness of a community-based combination HIV prevention package to include a range of biomedical, behavioral, and structural services, provided through the "STILETTO" Center. Trained peer educators (N=20) will conduct outreach in exotic dance club and street venues, promote the use of the Center, and enact community mobilization. The study's overall goal is to stimulate community empowerment, through such mechanisms as social cohesion and collective action, resulting in sustainable HIV risk reduction. We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer education, will lead to community empowerment and reduce HIV/STIs incidence and risk. The study aims to: 1) examine the effects of the intervention on FSWs' HIV risk behaviors (drug use/unprotected sex), and HIV/STI cumulative incidence over 18 months in the intervention (n=200) compared to those in the comparison (N=150) communities, and how these changes are associated with intervention exposure; 2) examine how socio-structural (e.g., social cohesion, stigma) and structural vulnerability indicators (e.g., financial and housing stability) change and are associated with the biological and behavioral outcomes over time in intervention (n=200) versus comparison (n=150) participants; and to 3) examine the intervention's implementation through qualitative (e.g., in-depth interviews) and quantitative (e.g., assessment of program fit, reach, facilitators and barriers, and program costs) measures. To achieve these aims, we propose developing and evaluating a theoretically informed, community-based comprehensive intervention comprised of the STILETTO Center, training FSW peer educators (N=20), and a 24-hour crisis hotline line. Our extensive community partners will provide services at the Center, thereby increasing sustainability. The study is innovative in its comprehensive approach targeting U.S. FSWs and addresses the growing call for designing and evaluating structural interventions, a NIDA priority (PA-12-281).

 描述（由申请人提供）：艾滋病毒流行三十年来，世界各地的女性性工作者中艾滋病毒/性传播感染的高感染率持续存在，而对美国女性性工作者的研究却很少，而对美国女性性工作者经历了一系列与耻辱等结构性因素相关的独特脆弱性的研究很少。这些因素抑制了保护性性行为以及寻求艾滋病毒检测、护理和治疗，以解决女性社会工作者感染艾滋病毒的社会和结构脆弱性，我们的目标是在全球范围内开发有效的方法。评估基于社区的艾滋病毒综合预防方案的有效性，其中包括通过“STILETTO”中心提供的一系列生物医学、行为和结构服务，训练有素的同伴教育者（N = 20）将在异国情调的舞蹈俱乐部和社区开展外展活动。该研究的总体目标是通过社会凝聚力和集体行动等机制促进社区赋权，从而可持续地降低艾滋病毒风险。立即的医疗需求，在与同伴教育相结合，将导致社区赋权并减少艾滋病毒/性传播感染的发病率和风险。该研究旨在：1）检查干预措施对女性妇女艾滋病毒危险行为（吸毒/无保护性行为）和艾滋病毒/性传播感染的影响。与对照社区 (N=150) 相比，干预社区 (n=200) 18 个月内的累积发病率，以及这些变化与干预暴露的关系；2) 检查社会结构（例如，社会）如何凝聚力、污名）和结构脆弱性指标（例如， 3) 通过定性（例如深入访谈）检查干预措施的实施情况； ）和定量（例如，评估计划适合度、范围、促进因素和障碍以及计划成本） 为了实现这些目标，我们建议制定和评估基于理论的、基于社区的综合干预措施，其中包括 STILETTO 中心、培训 FSW 同伴教育者（N = 20）以及我们广泛的社区合作伙伴的 24 小时危机热线。该研究将在该中心提供服务，提高可持续性。该研究针对美国 FSW 的综合方法具有创新性，并满足了日益增长的设计和评估结构性干预措施的需求，这是 NIDA 的优先事项 (PA-12-281)。