Sexual Health among Low-Income Female CSWs in China

描述（由申请人提供）：本研究旨在描述中国上海市流动和非流动女性街头流浪者（SW）的性健康、同伴社交网络和性健康的社会/认知关联。上海是中国最大的货运港口和主要的大都市区[1]。它有500万农村到城市的流动人口[2]和中国最高的性传播感染（STI）发病率[3-6]。这项研究的结果将用于指导未来针对移民和非移民街头步行者的纵向性健康风险降低研究的发展。在我们的试点研究中，处于性工作等级制度底部的“街头流浪者”（SW）据报道年龄较大，受教育程度较低，收入较低，与其他场所的性工作者相比，在性交易中不太可能使用保护措施。研究人员和公共卫生机构也承认，她们极难接触到[7-9]。人们对她们的性健康状况（如性传播感染、无保护和其他高风险性行为的流行程度）以及她们与工作性质的关系（如，同伴社会网络、群体规范、基于性别的关系权力和社会供给）。此外，尚不清楚移徙者和非移徙者街头流浪者的性行为有何不同。必须针对这一高危人群制定干预措施。要做到这一点，就必须建立关于其风险决定因素及其发生背景的可靠和有效的数据。这是这项拟议研究的首要目标。在当前的应用中，我们将首次使用受访者驱动抽样（RDS）来招募中国的女性街头步行者（200名移民和100名非移民）。具体目标是：（1）描述和比较无保护的性行为和性传播感染的流行率（2）通过形成性质性访谈和RDS联系指数，描述和比较流动与非流动街头流浪者的同伴社交网络特征;以及（3）测试一个将无保护的性行为和性传播感染流行率与个人层面的社会认知因素（例如，流动人口和非流动人口街头步行者人群中的性传播感染风险感知、坚持使用安全套的自我效能、使用安全套的预期结果）和背景社会文化因素（例如，基于性别的性关系权力、同伴社会网络、群体规范）。这项拟议中的研究意义重大，因为它关注的是不断增长的高风险和研究不足的人群：中国的街头步行者。该项目创新性地使用了农村发展数据库，在这一难以接触到的人群中进行招募，并评估了同龄人社交网络及其与移徙者和非移徙者街头步行者性健康的关系。这项研究的结果将对促进性健康和疾病预防/干预产生深远的影响，特别是那些使用“同伴教育”模式的人，以中国和其他地方的街头流浪者为目标。 公共卫生相关性：这项为期2年的研究的主要目标是描述性健康，同伴社交网络，和认知和社会协会的性健康之间的流动和非流动女性街头流浪者（SW）在上海，中国。上海是中国最大的都市区之一，拥有中国所有城市中最大的流动人口和最高的性病发病率。这项研究的结果将用于指导未来针对街头步行者的纵向性健康风险降低研究的发展。

DESCRIPTION (provided by applicant): The study aimed to characterize the sexual health, peer social networks, and social/cognitive associates of sexual health among migrant and non-migrant female Street Walkers (SW) in Shanghai, China. Shanghai is China's largest cargo port and a major metropolitan area [1]. It has 5 million rural-to-urban migrant population [2] and the highest sexually transmitted infection (STI) incidence rate [3-6] in China. The findings from this study will be used to guide the development of a future longitudinal sexual health risk reduction study targeting migrant and non-migrant street walkers. "Street walkers"(SW), who are at the bottom of the sex work hierarchy[13-15], were reported to be older, less educated, lower-paid, and less likely to use protection in sexual transactions compared to sex worker from other venues in our pilot study. They are also acknowledged by researchers and public health agencies to be extremely difficult to reach [7-9].Little is known about their sexual health (e.g. prevalence of STI, unprotected and other high-risk sexual behavior) and how they associated with the nature of their work (e.g., peer social network, group norm, gender-based relational power, and social provision). In addition, it is not clear how sexual practices differ between migrant and non-migrant street walkers. Interventions must be developed to target this high-risk population. To do so, it is critical to establish reliable and valid data regarding their determinants of risk and the context in which this occurs. It is the overarching goal of this proposed study. In the current application we Respondent Driven Sampling (RDS) will be used for the first time to recruit female street walkers in China (200 migrants vs. 100 non-migrants). The specific aims are to: (1) describe and compare the prevalence of unprotected sexual practices and STIs (Chlamydia, gonorrhea, syphilis, HSV-2, and HBV) between migrant and non-migrant street walkers; (2) describe and compare the characteristics of peer social networks of migrant and non-migrant street walkers based on formative qualitative interviews and RDS affiliation indices; and (3) test a working conceptual model relating unprotected sexual practices and STI prevalence to individual level social cognitive factors (e.g., perceived STI risk, self efficacy of consistent condom use, outcome expectancy of condom use) and contextual social cultural factors (e.g, gender-based sexual relationship power, peer social network, group norms) in the migrant and non-migrant street walker populations. The proposed study is significant as it focuses on a growing high-risk and under-studied population: street walkers in China. The project is innovative in its use of RDS for recruitment in this hard to reach population and in its assessment of peer social networks and their association with sexual health among both migrant and non-migrant street walkers. Findings from the proposed study will have far reaching implications for sexual health promotion and disease prevention / interventions, particularly those using "peer education" models, to target street walkers in China and elsewhere. PUBLIC HEALTH RELEVANCE: The primary goal of this 2-year study is to characterize the sexual health, peer social networks, and cognitive and social associates of sexual health among migrant and non-migrant female Street Walkers (SW) in Shanghai, China. Shanghai is one of the largest metropolitan areas in China and has the largest migrant population and the highest STI incidence rate of all Chinese cities. The findings from this study will be used to guide the development of a future longitudinal sexual health risk reduction study targeting street walkers.