Social network and sexual risk for HIV/STIs among older female sex workers

描述（由申请人提供）：中国面临着新的艾滋病毒/性传播感染挑战：艾滋病毒/性传播感染正在老年人（50岁以上）中蔓延。艾滋病毒/性传播感染在老年人中的流行是由老年女性性工作者（e35岁）推动的，大多数感染艾滋病毒的老年人报告说，他们与这些妇女有廉价商业性行为的历史。因此，有效的干预措施必须针对老年女性性工作者-艾滋病毒/性传播感染的主要来源。然而，目前很少有来自社区研究的流行病学数据来研究中国老年女性性工作者感染艾滋病毒/性传播疾病的性风险的性质和背景。我们的长期目标是制定一种对老年女性性工作者具有文化敏感性的艾滋病毒/性传播感染干预措施。在这个特定的应用程序的目标是量化的集体作用的社会网络组件（关系，结构和功能）和环境因素（物理，社会和政治因素）对艾滋病毒/性传播感染的风险行为在老年女性性工作者。中心假设是，基于网络的人际因素介导的影响，环境因素对艾滋病毒/性病的风险行为，在35岁或以上的女性性工作者。这一假说的提出是基于社会生态模型、中国集体主义文化的特点以及我们对社交网络的研究。我们将通过以下具体目标来实现这一目标：（1）定性描述中国老年女性性工作者性风险的环境和社会网络因素;（2）确定艾滋病毒和梅毒的患病率;（3）定量研究社会网络成分和环境因素对艾滋病毒/性传播疾病性风险的集体作用。目标1将通过与老年女性性工作者和利益攸关方（例如，皮条客以及美容院和旅馆的老板）。目标2和3将通过对中国三个城市（N= 1，200; 400/研究中心）从其社会网络关系中招募的老年女性性工作者进行基于社区的调查来实现。这项研究意义重大，因为（1）对老年女性性工作者性风险的环境和社会网络因素知之甚少;（2）研究结果将用于开发第一个基于理论的艾滋病干预措施，该干预措施对中国老年女性性工作者具有文化敏感性。该应用是创新的，因为（1）它是由社会生态模型和社会网络模型指导的;（2）它应用了一种新的基于网络的抽样方法（即，（3）采用现场艾滋病毒和梅毒生物检测和现场前列腺特异性抗原生物检测来验证自我报告的避孕套使用情况。这项研究的预期结果将产生重要的积极影响，因为一旦了解了性风险的多方面因素的集体作用，就可以制定有效针对这些因素的干预战略，从而采取创新办法预防老年女性性工作者的性风险，最终减少艾滋病毒通过性途径传播给老年人的情况。

DESCRIPTION (provided by applicant): China faces a new HIV/STI challenge: HIV/STIs are spreading among the older adult population (e 50 years). The HIV/STI epidemics in older adults are driven by older female sex workers (e35 years), with the majority of HIV infected older adults reporting a history of cheap commercial sex with these women. Therefore, effective interventions must target older female sex workers - the main source of HIV/STI transmission. However, few epidemiologic data from community-based studies are currently available to examine the nature and contexts of sexual risk for HIV/STIs among older female sex workers in China. Our long-term goal is to develop an HIV/STI intervention that is culturally sensitive for older female sex workers. The objective in this particular application is to quantify the collective roles of social network components (relations, structures, and functions) and environmental factors (physical, social and political factors) on HIV/STI risk behavior in older female sex workers. The central hypothesis is that network-based interpersonal factors mediate the effects of environmental factors on HIV/STI risk behavior in female sex workers aged 35 years or older. The formulation of this hypothesis is based on the social ecological model, the feature of Chinese collectivistic culture, and our previous studies of social networks. We will achieve the objective by pursuing the following specific aims: (1) qualitatively describe environmental and social network factors for sexual risk among older Chinese female sex workers; (2) determine the prevalence of HIV and syphilis; and (3) quantitatively examine the collective roles of social network components and environmental factors on sexual risk for HIV/STIs. Aim 1 will be addressed by conducting in-depth interviews with older female sex workers and focus groups with stakeholders (e.g., pimps and owners of beauty salons and hotels). Aims 2 and 3 will be accomplished through a community-based survey of older female sex workers recruited from their social network ties in three cities in China (N=1,200; 400/site). This study is significant since (1) little is known about the environmental and social network factors for sexual risk among older female sex workers; and (2) findings will be used to develop the first theory-based HIV intervention that is culturally sensitive for older Chinese female sex workers in China. The application is innovative as (1) it is guided by the social ecological model and social network model; (2) it applies a novel network-based sampling method (i.e., respondent-driven sampling) to recruit more representative samples at the community level; and (3) it uses on- site bio-tests for HIV and syphilis and an on-site bio-test for prostate-specific antigen to validate self-reported condom use. The expected findings of the study will have an important positive impact, because, once the collective roles of the multi-faceted factors for sexual risk are known, intervention strategies can be developed to effectively target these factors, resulting in innovative approaches to the prevention of sexual risk for older female sex workers, which will ultimately reduce the sexual transmission of HIV to the older adult population.