Migration, Tourism and the HIV-drug use Syndemic in the Dominican Republic

描述(申请人提供)：加勒比地区的艾滋病毒感染率仅次于撒哈拉以南非洲，是世界上第二高的地区，也是该地区受非法药物使用和贩毒影响最严重的地区之一。这项拟议的混合方法合作研究以多米尼加共和国男性改变工作、移民以及性和药物使用行为为重点，考察了移民男性中艾滋病毒风险和药物使用与(1)移民模式和(2)旅游区社会环境之间的关系。我们通过旅游生态的概念将当代人口变化与艾滋病毒和毒品使用做法联系起来。旅游生态是指地理上受限的地区，在这些地区，五个生态特征(社会隔离；社会耻辱；商业规范；旅游逃避；以及毒品和酒精供应)被假设为导致高风险行为的原因。我们的研究基本上依赖于一个长期存在的多部门社区咨询委员会，该委员会由私人旅游代表、政府、公共卫生官员和民间社会组成。数据收集包括：(1)对两个沿海旅游区的36名男性农民工进行半结构化访谈(每个受试者两次访谈=72次会议)；(2)在两个旅游区使用Arc-GIS绘制民族志地图和进行空间分析；(3)对两个研究地点的400名农民工进行横断面调查；(4)对40名农民工进行试点干预。这项研究在三个关键方面对公共卫生知识和健康促进做出了贡献。首先，它确定了旅游区中贡献最大的因素 与艾滋病毒风险和药物使用密切相关，有助于制定和试点循证干预措施。其次，它借鉴了大量的文献，系统地分析了艾滋病毒和毒品使用的高危环境中旅游环境对健康的影响。最后，它将参与性过程纳入研究，这将加强当地相关性、研究翻译和 对卫生政策和项目的影响。

DESCRIPTION (provided by applicant): The Caribbean region has the second highest prevalence rates of HIV in the world following sub-Saharan Africa and is one of the region's most affected by illicit drug use and drug trafficking. Focusing on men's changing work, migration, and sexual and drug use behavior in the Dominican Republic, the proposed mixed- methods collaborative study examines how HIV risk and drug use among migrant men are related to (1) patterns of migration and (2) the social environments of tourism areas. We relate contemporary demographic changes to HIV and drug use practices through the notion of tourism ecologies - geographically constrained areas in which five ecological features (social isolation; social stigma; business norms; touristic escapism; and drug and alcohol availability) are hypothesized to contribute to high risk behaviors. Our research relies fundamentally on a long-standing multisectoral Community Advisory Board involving private tourism representatives, government, public health officials, and civil society. Data collection consists o: (1) semi- structured interviews with 36 systematically selected male migrant workers in two coastal tourism areas (two interviews per subject = 72 sessions); (2) ethnographic mapping and spatial analysis using Arc-GIS in two tourism areas; (3) a cross-sectional survey with 400 male migrant workers in two research sites; and (4) the implementation of a pilot intervention with 40 migrant male tourism workers. This study contributes to public health knowledge and health promotion in three key ways. First, it identifies the factors in tourism areas that most contribute to HIV risk and drug use, contributing to the development and piloting of an evidence-based intervention. Second, it draws on an extensive literature to systematically analyze the health effects of tourism environments in high-risk settings for HIV and drug use. Finally, it incorporate a participatory process to research that will strengthen local relevance, research translation, and the impact on health policies and programs.