Concurrent Partnerships Among High-Risk Couples in the U.S.-Mexico Border Region

描述（由申请人提供）：拟议的论文研究项目（R36）的总体目标是进行性伴侣并发性的横断面混合方法研究（即，重叠的性伙伴关系），艾滋病毒和其他性传播感染（STI）流行病学的一个重要因素，在美国高风险，吸毒女性性工作者（FSW）和他们的非商业性亲密男性伴侣中，墨西哥边境地区。药物滥用、性工作和人口流动是该区域的特点，在包括性工作者和注射毒品使用者在内的高风险人群中出现了艾滋病毒/性传播感染的动态流行。虽然迄今为止这些艾滋病毒/性传播感染仍然集中，但性工作者-亲密伴侣二人组之间的并发性可能会迅速促进艾滋病毒/性传播感染与一般人群的“联系”。尽管大量的文献并发，很少有人知道的动机和背景周围的并发之间的边缘化，吸毒的二人组在西半球资源贫乏的环境。拟议的论文研究旨在描述高风险二人组（目标1）并发的社会背景，并确定美国高风险FSW（目标2）及其亲密男性伴侣（目标3）之间并发的性别特异性患病率和相关性。墨西哥边境地区。为了实现这些目标，我们将在项目Parejas（R 01-DA 02772; PI：S）中使用定性和定量方法实施横断面混合方法设计。斯特拉斯迪），一个现有的队列的200对高风险，吸毒FSW和他们的亲密男性伴侣在蒂华纳和镉。Juarez（共N=400例受试者）。为了达到目标1，我们将有目的地抽样约20名女性和约20名男性（N=40），报告最近（过去一年）的并发性在现有的基线定量调查，使用UNAIDS推荐的性伴侣历史模块测量并发性。我们将对这个子样本进行半结构化访谈，这将与母研究的数据收集不同，以定性地探索并发的含义和动机，包括可能促进或阻碍并发行为的社会和环境因素。然后，我们将使用紧急定性研究结果来制定一个概念框架和具体的假设，以指导定量分析。为了满足目标2和3，我们将使用来自整个队列200对（N=400）的现有定量基线数据。我们将确定并发流行率并应用多级（即，二元）逻辑回归，以确定个人和关系水平的并发性FSW（目标2）和他们的亲密男性伴侣（目标3）。我们的二元，混合方法的研究设计将提供第一个深入的调查并发在一个地区的特点是流行的药物使用，商业性，和人口流动。它还将使PI成为药物滥用研究中具有竞争力的新研究者。调查结果将是至关重要的循证，性别为基础的干预措施，以减少艾滋病毒/性传播感染的风险之间的药物使用性工作者及其亲密的男性伴侣的发展。 公共卫生相关性：拟议的论文研究项目（R36）将提供重要的洞察性伴侣并发的作用（即，重叠的性伙伴关系），艾滋病毒和其他性传播感染（STI）流行病学的一个重要因素，在美国高风险，吸毒女性性工作者（FSW）和他们的非商业性亲密男性伴侣中，墨西哥边境地区。虽然该区域的艾滋病毒/性传播感染仍然集中在性工作者和注射毒品使用者中，但性工作者及其亲密男性伴侣之间的并发性可能会促进艾滋病毒/性传播感染与一般人群的“联系”。在现有队列中使用定量和定性研究方法的建议（Proyecto Parejas; R 01-DA 02772; PI：S. Strathdee）将首次深入研究西半球资源匮乏环境中的性别特异性流行率、相关因素和并发的社会背景，从而产生重要的艾滋病毒预防干预影响，并将PI定位为药物滥用研究领域中具有竞争力的新研究者。

DESCRIPTION (provided by applicant): The overall goal of the proposed dissertation research project (R36) is to conduct a cross-sectional mixed methods study of sexual partner concurrency (i.e., overlapping sexual partnerships), an important factor in the epidemiology of HIV and other sexually transmitted infections (STIs), among dyads of high-risk, drug using female sex workers (FSWs) and their non-commercial, intimate male partners in the U.S.-Mexico border region. Substance abuse, sex work, and population mobility are features of the region, where a dynamic epidemic of HIV/STIs has emerged in high-risk populations including FSWs and injection drug users (IDUs). Although to date these HIV/STI epidemics remain concentrated, concurrency among FSW-intimate partner dyads could rapidly promote the "bridging" of HIV/STIs to the general population. Despite the vast literature on concurrency, little is known about the motivations for and contexts surrounding concurrency among marginalized, drug-using dyads in resource-poor settings in the Western Hemisphere. The proposed dissertation study seeks to characterize the social context of concurrency for high-risk dyads (Aim 1) and determine the gender-specific prevalence and correlates of concurrency among high-risk FSWs (Aim 2) and their intimate male partners (Aim 3) in the U.S.-Mexico border region. To meet these aims, we will implement a cross-sectional mixed methods design using qualitative and quantitative methods within Proyecto Parejas (R01-DA02772; PI: S. Strathdee), an existing cohort of 200 dyads of high-risk, drug-using FSWs and their intimate male partners in Tijuana and Cd. Juarez (N=400 subjects total). To meet Aim 1, we will purposively sample ~20 women and ~20 men (N=40) reporting recent (past year) concurrency in existing baseline quantitative surveys that measured concurrency using a UNAIDS-recommended sexual partner history module. We will conduct semi-structured interviews with this subsample, which will be distinct from data collection of the parent study, to qualitatively explore the meanings of and motivations for concurrency including social and environmental factors that may promote or discourage concurrency behaviors. We will then use emergent qualitative findings to develop a conceptual framework and specific hypotheses to guide quantitative analyses. To meet Aims 2 and 3, we will use existing quantitative baseline data from the entire cohort of 200 dyads (N=400). We will determine concurrency prevalence and apply multilevel (i.e., dyadic) logistic regression to identify individual- and relationship-level correlates of concurrency for FSWs (Aim 2) and their intimate male partners (Aim 3). Our dyadic, mixed methods study design will provide the first in-depth investigation of concurrency in a region characterized by prevalent drug use, commercial sex, and population mobility. It will also position the PI as a competitive new investigator in drug abuse research. Findings will be critical to the development of evidence-based, gender-specific interventions to reduce HIV/STI risk among drug-using FSWs and their intimate male partners. PUBLIC HEALTH RELEVANCE: The proposed dissertation research project (R36) will provide important insight into the role of sexual partner concurrency (i.e., overlapping sexual partnerships), an important factor in the epidemiology of HIV and other sexually transmitted infections (STIs), among dyads of high-risk, drug-using female sex workers (FSWs) and their non-commercial, intimate male partners in the U.S.-Mexico border region. Although HIV/STIs in this region remain concentrated among FSWs and injection drug users (IDUs), concurrency among FSWs and their intimate male partners could promote the "bridging" of HIV/STIs to the general population. The proposed use of quantitative and qualitative research methods within an existing cohort (Proyecto Parejas; R01-DA02772; PI: S. Strathdee) will provide the first in-depth examination of the gender-specific prevalence, correlates, and social contexts of concurrency in a resource-poor setting in the Western Hemisphere, leading to important HIV- prevention intervention implications and positioning the PI as a competitive new investigator in the field of drug abuse research.