Examining the Geographies of Immigrant Sex Work: An Exploratory Study of HIV Risk

描述（由申请人提供）：本研究针对纽约市（NYC）和洛杉矶（LA）的亚洲移民女性场所性工作者，旨在制定策略，以高效和有效地针对高风险性工作场所集群进行艾滋病毒风险降低干预。女性性工作者感染艾滋病毒等性传播疾病的风险很高，而且极易遭受暴力和剥削。很大一部分女性性工作者是亚洲移民，她们的脆弱性加剧，因为移民妇女的性工作可能是偿还移民债务和在缺乏其他就业选择时确保生存的更大战略的一部分。大多数与健康有关的性工作研究都侧重于街头卖淫，对“室内”或“街头外”性工作者艾滋病毒风险的了解存在很大差距，而近年来，这些性工作者已成为性工作行业的主导者。室内或街道外的性工作发生在按摩院等场所，或在酒吧和酒店等场所进行谈判。纽约市室内或街头场所性工作行业的增长部分归因于街头性工作者的逮捕，将性工作推向室内场所。同样，在洛杉矶，警方对按摩院等室内场所的监测，有助于在不需要监测和许可证的场所扩大室内性工作，如芳香疗法公司和日光浴沙龙。关于艾滋病毒风险，现有的几项关于移民室内场所女性性工作者的研究表明，一系列因素限制了安全套的持续使用，包括客户的胁迫、经济激励和场所的安全套使用政策。关于性工作者的其他研究一般表明，艾滋病毒风险因性工作的形式、性工作者和客户的人口统计以及其他风险因素的存在，特别是药物使用而有很大差异。这些因素可能在地理上聚集在一起，为更有效地确定风险目标提供了机会 减少干预。在本研究中，我们的目标是：1）测试一个概念模型，解释为什么在一些室内性工作场所集群中，艾滋病毒性危险行为的发生率较低，以确定性工作者的艾滋病毒知识和态度，场所文化，地理位置和当地政策执行的相对重要性; 2）利用第一个目标的结果，制定场所层面和地理上有针对性的干预策略，以有效地降低高风险性工作场所集群中的艾滋病毒风险。这项研究使用了性工作场所位置的地理信息系统地图，对性工作者的深入采访，以及对规范室内场所性工作的地方政策的分析。两个地点（纽约市和洛杉矶县），包括亚洲移民人口在美国最大的集中地，和三个种族的移民性工作者人口（中国，韩国和越南）是数据收集和分析的重点。研究结果将为未来的研究奠定基础，以制定和测试针对高风险室内性工作场所和场所集群的地理目标风险降低干预措施。

DESCRIPTION (provided by applicant): This study of Asian immigrant female venue-based sex workers in New York City (NYC) and Los Angeles (LA) aims to develop strategies for efficiently and effectively targeting HIV risk-reduction interventions to high-risk sex-work venue clusters. Female sex workers are at high risk for sexually transmitted infections, such as HIV, and highly vulnerable to violence and exploitation. A substantial portion of female sex workers are Asian immigrants, whose vulnerability is exacerbated because sex work for immigrant women may be part of a larger strategy to pay off migration debts and to ensure subsistence when there is a lack of other employment alternatives. Most health-related research on sex work has focused on street prostitution, leaving substantial gaps in knowledge about HIV risk for "indoor" or "off-street" sex workers, who have become dominant in the sex work industry in recent years. Indoor or off-street sex work occurs in venues such as massage parlors, or is negotiated in venues such as bars and hotels. The growth in the indoor or off-street venue-based sex work industry in NYC has been traced in part to arrests of street-based sex workers, driving sex work into indoor venues. Similarly, in LA, police monitoring of indoor venues such as massage parlors has contributed to expansion of indoor sex work in venues not requiring monitoring and licensure, such as aromatherapy firms and tanning salons. Regarding HIV risk, the few existing studies on immigrant indoor venue-based female sex workers indicate that a combination of factors limit consistent condom use, including coercion from clients, financial incentives and condom use policies at venues. Other research on sex workers in general suggests that HIV risk varies widely by the form of sex work, sex worker and client demographics, and presence of other risk factors, particularly substance use. These factors may cluster geographically, offering an opportunity to more efficiently and effectively target risk reduction interventions. In the proposed study, we aim to 1) test a conceptual model that explains why there are lower rates of HIV sexual risk behavior in some indoor sex work venue clusters in order to ascertain the relative importance of sex workers' HIV knowledge and attitudes, venue culture, geographic location and local policy enforcement; and 2) use findings from the first aim to develop venue-level and geographically targeted intervention strategies for efficiently and effectively reducing HIV risk in high-risk sex-work venue clusters. The study uses GIS mapping of sex-work venue locations, in- depth interviews with sex workers, and an analysis of local policies regulating indoor venue-based sex work. Two sites (NYC and LA County), comprising the largest concentrations of Asian immigrant populations in the US, and three ethnic immigrant sex worker populations (Chinese, Korean, and Vietnamese) are the focus for data collection and analysis. Findings will form the foundation for future studies to develop and test geographically targeted risk reduction interventions aimed at high-risk indoor sex work venues and venue clusters.