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

描述(申请人提供)：中国面临着艾滋病毒/性传播感染的新挑战：艾滋病毒/性传播感染正在老年人群中传播(e 50岁)。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有与这些妇女发生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检查中国老年女性性工作者艾滋病毒/性传播感染的性质和背景。我们的长期目标是开发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。这一特定应用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(物理、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在环境因素对35岁或以上女性性工作者艾滋病毒/性传播感染风险行为的影响中起中介作用。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之前对社会网络的研究。我们将通过追求以下具体目标来实现这一目标：(1)定性描述环境和社会网络因素对中国老年女性性工作者的性风险；(2)确定艾滋病毒和梅毒的流行率；(3)定量检查社会网络组成部分和环境因素对艾滋病毒/性传播感染的性风险的集体作用。目标1将通过对老年女性性工作者和利益攸关方(例如皮条客和美容院和酒店的老板)的重点小组进行深入访谈来实现。目标2和目标3将通过对中国三个城市(N=1,200；400个/站点)从社交网络中招募的老年女性性工作者进行社区调查来实现。这项研究意义重大，因为(1)环境和社会网络因素对老年女性性工作者的性风险知之甚少；(2)研究结果将被用来开发首个基于理论的艾滋病毒干预措施，对中国的老年女性性工作者具有文化敏感性。这项应用的创新之处在于：(1)它以社会生态模型和社会网络模型为指导；(2)它采用了一种新的基于网络的抽样方法(即受访者驱动的抽样)，以在社区层面招募更多具有代表性的样本；(3)它使用现场艾滋病毒和梅毒生物测试以及现场前列腺特异性抗原生物测试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，因为一旦获得性风险的多方面因素的集体作用，就可以制定干预战略，有效地针对这些因素，从而产生预防老年女性性工作者性风险的创新方法，最终将减少艾滋病毒对老年人口的性传播。

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.