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

描述（由申请人提供）：本研究以纽约和洛杉矶的亚裔移民女性性工作者为研究对象，旨在为高风险的性工作场所群体制定有效的艾滋病风险降低干预策略。女性性工作者感染艾滋病毒等性传播疾病的风险很高，而且极易受到暴力和剥削。很大一部分女性性工作者是亚洲移民，她们的脆弱性加剧了，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。大多数关于性工作的健康相关研究都侧重于街头卖淫，这使得“室内”或“非街头”性工作者对艾滋病毒风险的了解存在很大差距，近年来这些性工作者在性工作行业中占主导地位。室内或场外性工作发生在按摩院等场所，或在酒吧和酒店等场所进行协商。纽约市室内或非街头场所性工作行业的增长，部分原因是街头性工作者被逮捕，导致性工作进入室内场所。同样，在洛杉矶，警察对按摩院等室内场所的监控，导致了香薰公司和晒黑沙龙等不需要监控和许可的场所的室内性工作的扩大。关于艾滋病毒风险，现有的少数关于移民室内场所的女性性工作者的研究表明，多种因素限制了安全套的持续使用，包括客户的强迫、经济激励和场所使用安全套的政策。其他关于性工作者的研究表明，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数据以及其他风险因素（特别是药物使用）的存在而有很大差异。这些因素可能在地理上聚集在一起，从而提供了更有效地定位风险的机会

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.