Evolving HIV/STI risk environments of FSWs on the Mexico/U.S. Border

墨西哥/美国不断变化的 FSW 艾滋病毒/性传播感染风险环境

• 批准号: 8132877
• 负责人: Kimberly C Brouwer
• 金额: $ 60.82万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8132877
• 关键词: Accounting; Affect; American; Area; Behavior; Behavioral; Books; Border Crossings; Characteristics; Chlamydia; Cities; Client; Collaborations; Communicable Diseases; Communities; Computer Assisted; Data; Data Analyses; Development; Diffusion; Drug usage; Economics; Environment; Environmental Impact; Environmental Risk Factor; Epidemic; Epidemiology; Evolution; Female; Frequencies; Future; Geographic Information Systems; Geography; Goals; Gonorrhea; HIV; Health; Health Services Accessibility; Herpes zoster disease; Human immunodeficiency virus test; Illicit Drugs; Incidence; Individual; Industry; Institution; Intervention; Interview; Laws; Life; Link; Location; Maps; Measurement; Methods; Mexican; Mexico; Military Personnel; Monitor; Murder; NIH Office of AIDS Research; National Institute of Drug Abuse; Natural experiment; Nature; Outcome; Participant; Pattern; Perception; Pharmaceutical Preparations; Police; Population; Prevalence; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Research Priority; Risk; Risk Behaviors; Rosa; Services; Sex Characteristics; Sexually Transmitted Diseases; Social Characteristics; Social Work; Staging; Substance abuse problem; Surveys; Syphilis; Syringes; Testing; Time; Travel; Unsafe Sex; Urban Renewal; Violence; Woman; Work; Workplace; base; behavior change; condoms; disease transmission; disorder risk; follow-up; influenza outbreak; killings; meetings; migration; novel; novel strategies; prevent; sex; social; spatial relationship; swine flu; tool; transmission process

DESCRIPTION (provided by applicant): There is growing recognition of the importance of 'place' on individual risk of disease, although most studies fail to capture the dynamic nature of the risk environment and its effect on the sex trade has been understudied. The Mexico/US border region is undergoing profound alterations in the environment in which sex work takes place, providing a 'natural experiment' through which we can explore the relative contributions of individual and structural factors on HIV transmission. The primary goals of this research are to define social, spatial, and physical factors affecting female sex workers (FSWs) in 2 border cities and determine their relevance to HIV epidemiology, drug use, and access to services. Tijuana and Ciudad (Cd.) Juarez have witnessed escalating community-level violence and, for Cd. Juarez, changes in the location and visibility of the 'red light' district. While migration and cross-border interactions are major influences, the recent global economic downturn is dramatically altering migration patterns. Based on the above, the specific aims of this project are to: 1) assess changes in social influences on the sex work risk environment over time in both cities and their effect on risk behaviors, HIV/STI incidence, and access to services; 2) determine the locations where FSWs live, work and engage in other activities and their relationship to risk behaviors, perceptions of violence, and access to services; and 3) determine the extent to which the built environment and other sex work venue characteristics relate to individual-level behaviors and HIV/STI incidence. To meet these aims, we will recruit 600 FSWs (300 per city) and collect sociodemographic, location, and behavioral data through interviews. All will be tested for HIV, syphilis, gonorrhea, and Chlamydia and treated as needed. Follow-up interviews and testing will occur at months 6, 12, and 18. To meet aim 2, we will construct a geographic information system (GIS) of both cities and explore factors in relation to where FSWs live, work, buy/use drugs, and access services. Changing spatial relationships, such as the dispersal of the Cd. Juarez Zona Roja and intra-urban or cross-border mobility, will be analyzed to track patterns of infectious disease spread. We will also conduct in-depth interviews and an activity-travel survey with 30 sex workers per city, stratified by geography and venue (e.g. street, bar, etc.) to create geo-narratives based on time-geographic methods and computer-aided qualitative data analysis in order to explore the impact of recent social, economic, political, and other structural changes on participants' lives. To meet aim 3, field measurements of the built environment and other venue characteristics will be combined with individual-level data to explore their effect on health outcomes. The data collected will provide information vital to reframing HIV and drug use interventions to take into account the structural environment. This project is timely as HIV prevalence is rising along the U.S./Mexico border, presenting a window of opportunity to prevent transition to a generalized epidemic.

描述（由申请人提供）：人们越来越认识到“地点”对个人疾病风险的重要性，尽管大多数研究未能捕捉到风险环境的动态性质，并且其对性交易的影响尚未得到充分研究。墨西哥/美国边境地区的性工作环境正在发生深刻的变化，这提供了一个“自然实验”，通过它我们可以探索个人和结构因素对艾滋病毒传播的相对影响。本研究的主要目标是确定影响两个边境城市女性性工作者 (FSW) 的社会、空间和物理因素，并确定它们与艾滋病毒流行病学、吸毒和获得服务的相关性。蒂华纳 (Tijuana) 和华雷斯城 (Ciudad (Cd.) Juarez) 见证了社区暴力不断升级，对于 CD.华雷斯，“红灯”区的位置和能见度发生变化。虽然移民和跨境互动是主要影响因素，但最近的全球经济衰退正在极大地改变移民模式。基于上述，本项目的具体目标是： 1）评估两个城市性工作风险环境的社会影响随时间的变化及其对风险行为、艾滋病毒/性传播感染发病率和获得服务的影响； 2) 确定FSW生活、工作和从事其他活动的地点及其与危险行为、暴力观念和获得服务的关系； 3) 确定建筑环境和其他性工作场所特征与个人行为和艾滋病毒/性传播感染发病率的相关程度。为了实现这些目标，我们将招募 600 名 FSW（每个城市 300 名），并通过访谈收集社会人口统计、位置和行为数据。所有人都将接受艾滋病毒、梅毒、淋病和衣原体检测，并根据需要进行治疗。后续访谈和测试将在第 6、12 和 18 个月进行。为了实现目标 2，我们将构建两个城市的地理信息系统 (GIS)，并探讨与 FSW 生活、工作、购买/使用地点相关的因素药物和无障碍服务。改变空间关系，例如镉的扩散。将分析华雷斯州的红色区和城市内或跨境流动，以追踪传染病的传播模式。我们还将对每个城市的 30 名性工作者进行深度访谈和活动旅行调查，按地理位置和地点（例如街道、酒吧等）进行分层，以创建基于时间地理方法和计算机辅助的地理叙事定性数据分析，以探索近期社会、经济、政治和其他结构性变化对参与者生活的影响。为了实现目标 3，建筑环境和其他场馆特征的现场测量将与个人数据相结合，以探索它们对健康结果的影响。收集的数据将提供对于重新制定艾滋病毒和吸毒干预措施以考虑结构环境至关重要的信息。该项目非常及时，因为美国/墨西哥边境的艾滋病毒感染率正在上升，为防止向普遍流行病转变提供了机会之窗。