HIV Risk Environments among FSW and DU: A Longitudinal Ethno-Spatial Approach

描述（由申请人提供）：本申请的目的是应用一种新的民族空间方法来评估社会、结构和环境因素对非法吸毒者（DU）和女性性工作者（FSW）的艾滋病毒风险行为、艾滋病毒发病率和艾滋病毒治疗结果的影响。此外，我们还试图探索在这些人群中形成风险轨迹的关键起始和过渡事件。我们提出的研究嵌套在一个更大的研究项目中，该项目包括五个nida资助的纵向队列研究，研究对象是加拿大温哥华的成年DU、FSW和街头青年。因此，我们的方法提供了一个“增值”的机会，可以使用和整合多种数据收集和分析技术，以确定性工作和吸毒场景的社会、结构和物理特征对艾滋病毒结果的影响，并将包括人种学观察田野调查、深度访谈、地理空间测绘技术以及定量实验室和调查数据。通过这一努力，我们将通过试点一种新的民族空间方法来阐明DU和FSW中艾滋病毒风险和艾滋病毒治疗的复杂途径，寻求推进弱势群体中艾滋病毒/艾滋病研究的方法学方法。此外，我们的目标是创建一个平台，对未来针对DU和FSW的干预措施进行持续的民族空间评估，这可以在北美的其他环境中复制。温哥华市是进行拟议研究的理想场所。像美国的许多城市一样，温哥华是毒品和性工作场所的所在地，并且在DU和FSW中经历了很高的艾滋病毒感染负担。与美国几个城市的官员一样，温哥华的官员正在实施一系列政策和干预措施，旨在减少吸毒和性工作对公共卫生和公共秩序的影响，包括涉及警务、支持性住房和改造物质环境的政策和干预措施。新出现的大量证据表明，虽然这些干预措施可以减少公共混乱，但它们往往对弱势群体产生意想不到的负面影响，促使人们呼吁将公共卫生和公共秩序举措结合起来。然而，这些干预措施对艾滋病毒风险行为、艾滋病毒发病率和艾滋病毒治疗结果的影响尚未完全阐明。同样，对DU和FSW之间形成风险轨迹的关键起始和过渡事件的相关影响也没有得到很好的理解。在全球范围内，人们日益认识到需要查明社会、结构和物质环境如何影响边缘化吸毒人口的健康，以及干预措施如何能够处理这些程度的影响。评估社会和结构影响以及促进方法多样性已被确定为艾滋病研究办公室2011年跨国立卫生研究院计划的优先事项。因此，通过采用互补和创新的混合方法研究，我们的目标是解决若干紧迫的保健挑战，这将为加拿大和美国制定一系列政策和干预措施提供信息。

DESCRIPTION (provided by applicant): The purpose of this application is to apply a novel ethno-spatial approach to evaluate the impact of social, structural, and environmental factors on HIV risk behavior, HIV incidence, and HIV treatment outcomes among illicit drug users (DU) and female sex workers (FSW). As well, we seek to explore critical initiation and transition events that shape risk trajectories within these populations. Our proposed study is nested within a larger program of research that includes five NIDA-funded longitudinal cohort studies of adult DU and FSW and street-involved youth in Vancouver, Canada. Thus, our approach offers a 'value-added' opportunity to employ and integrate multiple data collection and analytic techniques to identify the impacts of social, structural and physical features of sex work and drug use scenes on HIV outcomes, and will include ethnographic observational fieldwork, in- depth interviews, geo-spatial mapping techniques, and quantitative laboratory and survey data. Through this effort we will seek to advance methodological approaches to the study of HIV/AIDS among vulnerable populations, by piloting a novel ethno-spatial approach to elucidate the complex pathways to HIV risk and HIV treatment among DU and FSW. Further, we aim to create a platform for the ongoing ethno-spatial evaluation of future interventions targeting DU and FSW that can be replicated in other settings within North America. The city of Vancouver is an ideal setting for the proposed research. Like many cities in the US, Vancouver is home to established drug and sex work scenes, and has experienced a high burden of HIV infection among DU and FSW. Officials in Vancouver, like those in several US municipalities, are implementing a range of policies and interventions aimed at reducing the public health and public order impacts of drug use and sex work, including those involving policing, supportive housing, and modifications to the physical environment. A nascent body of evidence suggests that while these interventions can reduce public disorder, they often have unintended negative consequences for vulnerable populations, prompting calls for an integration of public health and public order initiatives. However, the impact of such interventions on HIV risk behavior, HIV incidence, and HIV treatment outcomes has not been fully elucidated. Likewise, the associated impacts on critical initiation and transitional events among DU and FSW that shape risk trajectories are not well understood. Globally, there is growing recognition of the need to identif how social, structural and physical environments affect the health of marginalized drug using populations, and how interventions can address these levels of influence. The evaluation of social and structural influences and the promotion of methodological diversity have been identified as high priorities within the Office of AIDS Research's Trans-NIH Plan for 2011. Accordingly, through the use of complementary and innovative mixed-methods research, we aim to address several urgent health challenges, which will inform the development of a range of policies and interventions in both Canada and the United States. PUBLIC HEALTH RELEVANCE: While there has been growing recognition of the important role that social, structural, and environmental factors play in shaping HIV risks among drug users and female sex workers within North America, there has been limited evaluation of the broader risk environment and HIV risk behavior, HIV incidence, and HIV treatment outcomes among these populations. This project seeks to address this gap by implementing a novel longitudinal ethno-spatial approach to elucidate the complex pathways between social, structural, and physical environments within sex work and drug scenes and HIV risk and HIV treatment among drug users and female sex workers. As well, we seek to explore critical initiation and transition events that shape risk trajectories within these populations.