Social and structural context of HIV/STI risk among FSWs

FSW 中艾滋病毒/性传播感染风险的社会和结构背景

• 批准号: 8282627
• 负责人: Kate Shannon
• 金额: $ 41.09万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8282627
• 关键词: 19 year old; Acquired Immunodeficiency Syndrome; Address; Adopted; Adult; American; Baltimore; Biological Markers; Canada; Cities; Client; Cohort Studies; Communities; Community Workers; Data; Data Sources; Developed Countries; Developing Countries; Drug usage; Drug user; Effectiveness; Environment; Epidemic; Epidemiologic Methods; Epidemiology; Evaluation; Female; Funding; Gender; General Population; Geographic Information Systems; Goals; Guidelines; HIV; HIV Infections; Health; Human Herpesvirus 2; Incidence; Individual; Infection prevention; Injecting drug user; Injection of therapeutic agent; Institutes; Interdisciplinary Study; International; Intervention; Intervention Studies; Interview; Legal; Location; Maps; Marketing; Mediation; Modeling; Monitor; Nature; Neighborhoods; New York; North America; Outcome; Pattern; Pharmaceutical Preparations; Physical environment; Play; Policies; Population; Positioning Attribute; Prevalence; Prevention strategy; Prospective Studies; Questionnaires; Recruitment Activity; Reporting; Research; Resources; Risk; Role; Sampling; San Francisco; Screening procedure; Sexual Transmission; Sexually Transmitted Diseases; Shapes; Social Environment; Social Impacts; Statutes and Laws; Time; United States National Institutes of Health; Violence; Vulnerable Populations; Woman; Work; Workplace; base; cohort; contextual factors; experience; follow-up; innovation; meetings; mortality; novel; prospective; public health relevance; sex; social; stem; supported housing; theories; trend

DESCRIPTION (provided by applicant): The purpose of this application is to use social epidemiological methods to prospectively evaluate the impact of social, environmental, and structural factors on partner-level sexual and drug risk patterns and HIV and sexually transmitted infection (STI) incidence among FSWs and to assess the feasibility of a subsequent HIV/STI intervention targeting FSWs in public place-based settings (e.g. bars, streets). Despite growing evidence of the effectiveness of environmental-structural HIV/STI interventions targeting FSWs, this research has been largely derived from developing country settings and establishment-based venues, and there is limited prospective data on the social and structural context of HIV/STI risk among FSWs in North America. Given recent reports suggest a temporal shift from an injection to a sexually-driven HIV epidemic among street-involved populations in many North American settings, there is a crucial need for more prospective data on the contextual factors promoting and constraining partner-level sexual and drug risk patterns and HIV/STI acquisition. Vancouver, Canada is ideally suited for the proposed study for several reasons. First, due to the quasi-criminalized nature of sex work and large informal tolerance zones, we are in a unique position to evaluate the context of HIV/STI risk among FSWs, not currently feasible in most US cities. Second, unlike many urban environments where the FSW community is fragmented, the current social and legal context of sex work in Canada, our ability to harness strong community FSW support for this application, and new supportive housing models currently operating legally as quasi-brothels demonstrate significant innovation and strong potential for a subsequent intervention stemming from the results of this research. Herein we propose to create an open prospective cohort of 500 active FSWs working in public place-based settings, including interview administered questionnaires and HIV/STI screening at baseline and 6monthly follow-up over a five year period. To our knowledge this study is among the first prospective studies of public place-based sex work in North America and as such, we will be uniquely positioned to evaluate the risk environment and temporal trends in partner-level risks and HIV/STI acquisition among FSWs. This research will address several questions central to the urgent challenges facing HIV/STI prevention capacity in North America and will directly assess the feasibility of a subsequent intervention that will be of critical importance to other developed country settings. PUBLIC HEALTH RELEVANCE: While there is growing concern in many North American cities of a temporal shift from an injection to a sexually-driven HIV epidemic, there has been limited prospective evaluation of the broader risk environment and HIV and sexually transmitted infection (STI) incidence among FSWs. Using social epidemiological methods, this research will address this gap by evaluating the impact of the physical and social environment, gender inequities, and structural factors on partner-level sexual and drug risk patterns and HIV/STI acquisition among an open cohort of 500 FSWs.

描述（由申请人提供）：本申请的目的是使用社会流行病学方法，前瞻性地评估社会、环境和结构因素对性工作者伴侣层面的性和毒品风险模式以及艾滋病毒和性传播感染（STI）发病率的影响，并评估随后针对公共场所（如酒吧、街道）中的性工作者进行艾滋病毒/性传播感染干预的可行性。尽管越来越多的证据表明，针对性工作者的环境结构性艾滋病毒/性传播感染干预措施的有效性，这项研究主要来自发展中国家的设置和建立为基础的场地，并有有限的前瞻性数据的社会和结构背景下的艾滋病毒/性传播感染的风险在北美的性工作者。鉴于最近的报告表明，在北美许多地区，街头人口中的艾滋病毒流行从注射到性行为驱动的暂时转变，迫切需要更多关于促进和限制伴侣一级性和毒品风险模式以及艾滋病毒/性传播感染的背景因素的前瞻性数据。出于多种原因，加拿大温哥华非常适合进行拟议的研究。首先，由于性工作的准犯罪性质和大的非正式容忍区，我们处于一个独特的地位，以评估艾滋病毒/性传播感染的风险在FSW的背景下，目前在美国大多数城市是不可行的。第二，不像许多城市环境中的FSW社区是分散的，目前的社会和法律的背景下，性工作在加拿大，我们的能力，利用强大的社区FSW支持这一应用程序，和新的支持性住房模式，目前合法经营的准妓院表现出显着的创新和强大的潜力，随后的干预源于本研究的结果。在此，我们建议创建一个开放的前瞻性队列的500名活跃的女性性工作者在公共场所为基础的设置，包括访谈管理的问卷调查和艾滋病毒/性传播感染筛查在基线和6个月的随访超过五年的时间。据我们所知，这项研究是第一个前瞻性研究的公共场所为基础的性工作在北美，因此，我们将独特的定位，以评估风险环境和时间趋势的合作伙伴水平的风险和艾滋病毒/性病收购FSW之间。这项研究将解决北美艾滋病毒/性传播感染预防能力面临的紧迫挑战的几个核心问题，并将直接评估对其他发达国家环境至关重要的后续干预措施的可行性。 公共卫生关系：虽然在许多北美城市，人们越来越关注从注射到性驱动的艾滋病毒流行的时间转变，但对更广泛的风险环境以及FSW中的艾滋病毒和性传播感染（STI）发病率的前瞻性评估有限。使用社会流行病学的方法，这项研究将解决这一差距，通过评估的影响，物理和社会环境，性别不平等，和结构性因素的合作伙伴层面的性和毒品的风险模式和艾滋病毒/性传播感染的收购之间的开放队列的500 FSW。