High-risk Establishments and Women's HIV Prevention in Southern China

描述(申请人提供)：这项为期5年的研究，题为“中国南部的高危场所和妇女的艾滋病毒预防”，是一项第一阶段/第二阶段的研究，对于性工作场所的艾滋病毒风险和社会动态，以及在这些机构内进行的多层次、基于现场的干预措施的开发和评估，以促进在那里工作的妇女使用避孕套(FC)预防艾滋病毒/性传播疾病。在艾滋病与FIRCA研究的基础上，美国和中国的调查人员将与海南和广西的疾控中心以及当地社区合作，在这两个省的两个农村和两个中等城市城镇进行这项研究。这项研究的目的是：1)评估性工作场所的数量和性质，以及这些场所内影响提供和测试现场干预措施以促进使用FC预防艾滋病毒的稳定性和社会动态；2)评估与艾滋病毒风险有关的因素以及在这些场所工作的妇女中使用女性和男性避孕套预防艾滋病毒；3)制定、试点、进行过程评估，评估在这些机构开展的以现场为基础的多层次(个人、地点、社区)干预措施的短期有效性和潜在可持续性，并将其付诸实施，以及4)探索可能解释以下因素的因素：a)在不同机构和不同城镇提供的干预措施的可行性、可接受性和保真度方面的差异，以及b)不同机构和不同城镇的妇女之间干预措施的短期有效性和可持续性的差异。在每个城镇，我们将使用密集的民族志来评估性工作者和性工作机构的特点和动态，以及在这些机构进行干预的可行性、过程和结果。我们将在三个时间点(基线、基线后6个月和12个月)对所有4个城镇的性工作者进行横断面调查，以进行比较分析，以评估与艾滋病毒风险有关的城镇、性工作机构和个人一级的特征，以及干预措施的预防和结果。将对定性和定量数据进行三角分析，以建立对影响风险和干预结果的特征的最强有力的评估，并对促进或阻碍妇女在这些机构使用FC和其他预防措施的因素进行最全面的分析。FC干预措施的开发和测试具有重大的公共卫生影响，因为它有可能减少在这一高危人群及其性网络中更广泛的人群中的艾滋病毒性传播。

DESCRIPTION (provided by applicant): This 5-year study, entitled "High-risk Establishments and Women's HIV Prevention in Southern China," is a Phase I/Phase II study of HIV risk and social dynamics in sex-work establishments, and the development and evaluation of a multi-level, site-based intervention conducted within those establishments to promote use of the female condom (FC) for HIV/STD prevention among women who work there. Based on a collaboration developed through an AIDS-FIRCA study, U.S. and Chinese investigators will work with Hainan and Guanxi provincial CDCs and local communities to conduct the study in two rural and two mid-sized urban towns in these provinces. The study aims are: 1) to assess the number and nature of sex-work establishments in these towns, and the stability and social dynamics within these establishments that affect delivery and testing of a site-base intervention to promote FC use for HIV prevention; 2) to assess factors associated with HIV risk and use of female and male condoms for HIV prevention among women who work within these establishments; 3) to develop, pilot, conduct a process evaluation, assess short-term efficacy and potential sustainability of, and manualize a site-based, multi-level (individual, site, community) intervention conducted in these establishments to promote the FC for HIV/STD prevention, and 4) to explore factors likely to explain: a) variation in feasibility, acceptability, and fidelity of intervention delivered in different establishments and different towns, and b) variation in short-term efficacy and sustainability of the intervention among women in different establishments and different towns. In each town we will use intensive ethnography to assess the characteristics and dynamics of sex workers and sex-work establishments, as well as the feasibility, process, and outcomes of the intervention conducted in those establishments. We will conduct cross-sectional surveys of sex workers in all 4 towns at three time points (baseline, 6 and 12 months post-baseline) for comparative analyses to assess town-level, sex-work establishment, and individual-level characteristics associated with HIV risk and prevention and outcomes of the intervention. Qualitative and quantitative data will be triangulated to build the strongest assessment of characteristics that affect risk and intervention outcomes and to provide the most comprehensive analysis of factors that enhance or impede use of the FC and other prevention measures by women in these establishments. Development and testing of the FC intervention has significant public health implications because of its potential for reducing sexual HIV transmission in this high-risk population and in the broader population of their sexual networks.