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/性传播感染在老年人（如50岁）中蔓延。老年人中艾滋病毒/性传播疾病的流行是由年龄较大的女性性工作者（35岁）造成的，大多数感染艾滋病毒的老年人报告曾与这些妇女发生过廉价的商业性行为。因此，有效的干预措施必须针对年长的女性性工作者——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可用于调查中国老年女性性工作者中艾滋病毒/性传播感染风险的性质和背景。我们的长期目标是开发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。这个特殊应用程序的目标是量化社会网络组成部分（关系、结构和功能）和环境因素（身体、社会和政治因素）对老年女性性工作者艾滋病毒/性传播感染风险行为的集体作用。中心假设是基于网络的人际因素介导环境因素对35岁及以上女性性工作者HIV/STI风险行为的影响。这一假设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以往对社会网络的研究。我们将通过追求以下具体目标来实现这一目标：(1)定性地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HIV和梅毒的流行情况；(3)定量考察社会网络成分和环境因素对性传播感染风险的集体作用。目标1将通过与年长女性性工作者进行深入访谈和与利益相关者（如皮条客、美容院和酒店老板）进行焦点小组讨论来解决。目标2和目标3将通过对中国三个城市的老年女性性工作者进行社区调查来完成（N= 1200； 400/站点）。本研究具有重要意义，因为(1)对大龄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首个对中国老年女性性工作者具有文化敏感性的基于理论的艾滋病干预措施。其创新性体现在：(1)以社会生态模式和社会网络模式为指导；(2)采用新颖的基于网络的抽样方法（即受访者驱动抽样），在社区层面招募更具代表性的样本；(3)使用艾滋病毒和梅毒的现场生物测试和前列腺特异性抗原的现场生物测试来验证自我报告的避孕套使用情况。该研究的预期结果将产生重要的积极影响，因为一旦了解性风险的多方面因素的集体作用，就可以制定干预策略，有效地针对这些因素，从而产生创新的方法来预防老年女性性工作者的性风险，最终将减少艾滋病毒对老年成人的性传播。

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.