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

描述（申请人提供）：这项为期五年的研究题为“中国南方高危职业和妇女艾滋病毒预防”，是一项关于性工作场所艾滋病毒风险和社会动态的I/II期研究，旨在制定和评估一个多层次、在这些机构内开展基于地点的干预，以促进使用女用避孕套预防艾滋病毒/艾滋病;在那里工作的妇女预防性病。基于AIDS-FIRCA研究开展的合作，美国和中国的研究人员将与海南省和广西省疾病预防控制中心和当地社区合作，在这些省份的两个农村和两个中型城镇进行研究。研究的目的是：1）评估这些城镇性工作场所的数量和性质，以及这些场所内的稳定性和社会动态，这些稳定性和社会动态影响基于场所的干预措施的实施和测试，以促进使用FC预防艾滋病毒; 2）评估与艾滋病毒风险相关的因素，以及在这些场所内工作的妇女使用女用和男用避孕套预防艾滋病毒; 3）开发、试验、进行过程评估，评估短期功效和潜在的可持续性，并将基于现场的多层次在这些机构中进行（个人、场所、社区）干预，以促进FC预防艾滋病毒/性病，以及4）探索可能解释以下问题的因素：a）不同机构和不同城镇提供的干预措施的可行性、可接受性和忠实性存在差异，B）不同机构和不同城镇的妇女在干预措施的短期效力和可持续性方面存在差异。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场所的特征和动态，以及在这些场所进行干预的可行性，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，进行比较分析，以评估与艾滋病毒风险和预防以及干预结果相关的城镇水平、性工作场所和个人水平特征。将对定性和定量数据进行三角分析，以便对影响风险和干预结果的特征进行最有力的评估，并对促进或阻碍这些机构中的妇女使用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意义，因为它有可能减少这一高危人群及其性网络中更广泛人群的艾滋病毒性传播。

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.