HIV Risk Environments among FSW and DU: A Longitudinal Ethno-Spatial Approach

FSW 和 DU 之间的 HIV 风险环境：纵向民族空间方法

• 批准号: 8262512
• 负责人: Thomas Kerr
• 金额: $ 37.39万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-02-15 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8262512
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Affect; American; Budgets; Canada; Cities; Cohort Studies; Communities; Complex; Crime; Data; Data Collection; Development; Disease; Drug usage; Drug user; Environment; Environmental Risk Factor; Epidemiology; Ethnography; Evaluation; Event; Female; Foundations; Funding; Future; HIV; HIV Infections; HIV Seropositivity; HIV-1; Health; Home environment; Illicit Drugs; Incidence; Intervention; Interview; Laboratories; Maps; Measures; Methods; Modeling; Modification; Municipalities; National Institute of Drug Abuse; North America; Outcome; Pathway interactions; Pharmaceutical Preparations; Physical environment; Play; Police; Policies; Population; Population Intervention; Public Health; Qualitative Research; RNA; Research; Research Methodology; Risk; Risk Behaviors; Role; Shapes; Social Environment; Social Impacts; Social Sciences; Surveys; Techniques; Treatment outcome; United States; United States National Institutes of Health; Vulnerable Populations; Work; Youth; antiretroviral therapy; base; cohort; cost; design; experience; heuristics; innovation; novel; novel strategies; programs; response; sex; social; stem; supported housing; theories; urban public health

DESCRIPTION (provided by applicant): The purpose of this application is to apply a novel ethno-spatial approach to evaluate the impact of social, structural, and environmental factors on HIV risk behavior, HIV incidence, and HIV treatment outcomes among illicit drug users (DU) and female sex workers (FSW). As well, we seek to explore critical initiation and transition events that shape risk trajectories within these populations. Our proposed study is nested within a larger program of research that includes five NIDA-funded longitudinal cohort studies of adult DU and FSW and street-involved youth in Vancouver, Canada. Thus, our approach offers a 'value-added' opportunity to employ and integrate multiple data collection and analytic techniques to identify the impacts of social, structural and physical features of sex work and drug use scenes on HIV outcomes, and will include ethnographic observational fieldwork, in- depth interviews, geo-spatial mapping techniques, and quantitative laboratory and survey data. Through this effort we will seek to advance methodological approaches to the study of HIV/AIDS among vulnerable populations, by piloting a novel ethno-spatial approach to elucidate the complex pathways to HIV risk and HIV treatment among DU and FSW. Further, we aim to create a platform for the ongoing ethno-spatial evaluation of future interventions targeting DU and FSW that can be replicated in other settings within North America. The city of Vancouver is an ideal setting for the proposed research. Like many cities in the US, Vancouver is home to established drug and sex work scenes, and has experienced a high burden of HIV infection among DU and FSW. Officials in Vancouver, like those in several US municipalities, are implementing a range of policies and interventions aimed at reducing the public health and public order impacts of drug use and sex work, including those involving policing, supportive housing, and modifications to the physical environment. A nascent body of evidence suggests that while these interventions can reduce public disorder, they often have unintended negative consequences for vulnerable populations, prompting calls for an integration of public health and public order initiatives. However, the impact of such interventions on HIV risk behavior, HIV incidence, and HIV treatment outcomes has not been fully elucidated. Likewise, the associated impacts on critical initiation and transitional events among DU and FSW that shape risk trajectories are not well understood. Globally, there is growing recognition of the need to identif how social, structural and physical environments affect the health of marginalized drug using populations, and how interventions can address these levels of influence. The evaluation of social and structural influences and the promotion of methodological diversity have been identified as high priorities within the Office of AIDS Research's Trans-NIH Plan for 2011. Accordingly, through the use of complementary and innovative mixed-methods research, we aim to address several urgent health challenges, which will inform the development of a range of policies and interventions in both Canada and the United States. PUBLIC HEALTH RELEVANCE: While there has been growing recognition of the important role that social, structural, and environmental factors play in shaping HIV risks among drug users and female sex workers within North America, there has been limited evaluation of the broader risk environment and HIV risk behavior, HIV incidence, and HIV treatment outcomes among these populations. This project seeks to address this gap by implementing a novel longitudinal ethno-spatial approach to elucidate the complex pathways between social, structural, and physical environments within sex work and drug scenes and HIV risk and HIV treatment among drug users and female sex workers. As well, we seek to explore critical initiation and transition events that shape risk trajectories within these populations.

描述（由申请人提供）：本申请的目的是应用一种新颖的民族空间方法来评估社会、结构和环境因素对非法吸毒者中艾滋病毒危险行为、艾滋病毒发病率和艾滋病毒治疗结果的影响（ DU）和女性性工作者（FSW）。此外，我们还寻求探索影响这些人群风险轨迹的关键启动和过渡事件。我们提出的研究嵌套在一个更大的研究计划中，其中包括 NIDA 资助的五项纵向队列研究，对象是加拿大温哥华的成年 DU 和 FSW 以及街头青年。因此，我们的方法提供了一个“增值”机会，可以采用和整合多种数据收集和分析技术，以确定性工作和吸毒场景的社会、结构和身体特征对艾滋病毒结果的影响，并将包括人种学观察实地工作、深度访谈、地理空间测绘技术以及定量实验室和调查数据。通过这一努力，我们将尝试采用一种新的民族空间方法来阐明 DU 和 FSW 之间的 HIV 风险和 HIV 治疗的复杂途径，从而寻求推进弱势群体中 HIV/艾滋病研究的方法学方法。此外，我们的目标是创建一个平台，用于对未来针对 DU 和 FSW 的干预措施进行持续的民族空间评估，这些干预措施可以在北美其他环境中复制。温哥华市是拟议研究的理想环境。与美国许多城市一​​样，温哥华是毒品和性工作场所的所在地，并且在 DU 和 FSW 中艾滋病毒感染负担很高。与美国几个城市的官员一样，温哥华的官员正在实施一系列政策和干预措施，旨在减少吸毒和性工作对公共卫生和公共秩序的影响，包括涉及治安、支持性住房和改变物质环境的政策和干预措施。大量新证据表明，虽然这些干预措施可以减少公共秩序混乱，但它们往往会给弱势群体带来意想不到的负面影响，促使人们呼吁将公共卫生和公共秩序举措整合起来。然而，此类干预措施对艾滋病毒危险行为、艾滋病毒发病率和艾滋病毒治疗结果的影响尚未完全阐明。同样，DU 和 FSW 之间塑造风险轨迹的关键启动和过渡事件的相关影响尚不清楚。在全球范围内，人们越来越认识到需要确定社会、结构和自然环境如何影响边缘化吸毒人群的健康，以及如何采取干预措施来解决这些影响程度。艾滋病研究办公室 2011 年跨 NIH 计划中已将社会和结构影响的评估以及促进方法多样性确定为高度优先事项。因此，通过使用补充和创新的混合方法研究，我们的目标是解决一些紧迫的健康挑战，这将为加拿大和美国制定一系列政策和干预措施提供信息。 公共卫生相关性：虽然人们越来越认识到社会、结构和环境因素在影响北美吸毒者和女性性工作者的艾滋病毒风险方面发挥着重要作用，但对更广泛的风险环境和艾滋病毒的评估仍然有限。这些人群中的危险行为、艾滋病毒发病率和艾滋病毒治疗结果。该项目旨在通过实施一种新颖的纵向民族空间方法来解决这一差距，以阐明性工作和毒品场景中的社会、结构和物理环境与吸毒者和女性性工作者中的艾滋病毒风险和艾滋病毒治疗之间的复杂路径。此外，我们还寻求探索影响这些人群风险轨迹的关键启动和过渡事件。