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

描述(由申请人提供)：这项针对纽约(NYC)和洛杉矶(LA)的亚洲移民女性场所性工作者的研究旨在制定战略，有效地将艾滋病毒风险降低干预措施对于性工作高危场所群。女性性工作者感染艾滋病毒等性传播疾病的风险很高，非常容易受到暴力和剥削。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，因为移民女性的性工作可能是偿还移民债务和在缺乏其他就业选择的情况下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集中在街头卖淫上，这在“室内”或“非街头”性工作者对艾滋病毒风险的认识上留下了相当大的空白，近年来，他们在性工作行业占据了主导地位。室内或街道外的性行为发生在按摩院等场所，或在酒吧和酒店等场所谈判。纽约市室内或非街道场所性工作行业的增长在一定程度上可以追溯到街头性工作者的被捕，驱使性工作进入室内场所。同样，在洛杉矶，警方对按摩院等室内场所的监控有助于扩大不需要监控和许可的场所的室内性工作，如芳香疗法公司和日光浴沙龙。关于艾滋病毒风险，现有的为数不多的关于移民室内场所女性性工作者的研究表明，限制持续使用避孕套的因素综合起来，包括来自客户的胁迫、经济奖励和场所避孕套使用政策。其他关于性工作者的研究表明，艾滋病毒风险因为性工作的形式、性工作者和客户的人口统计数据以及其他风险因素的存在，特别是药物使用的存在，而存在很大差异。这些因素可能在地理上聚集在一起，从而提供了更高效、更有效地瞄准风险的机会 减少干预措施。在拟议的研究中，我们的目标是1)测试一个概念模型，该模型解释了为什么在一些室内性工作场所群中艾滋病毒风险行为的比率较低，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；以及2)利用第一个目标的发现，制定场馆水平和地理目标的干预策略，以有效和有效地降低高危性工作场所群中的艾滋病毒风险。这项研究使用了性工作场所地点的地理信息系统地图，对性工作者的深入采访，以及对管理基于室内场所的性工作的当地政策的分析。数据收集和分析的重点是两个地点(纽约市和洛杉矶县)，其中包括美国最大的亚洲移民人口密度，以及三个少数民族移民性工作者人口(中国人、韩国人和越南人)。研究结果将为未来的研究奠定基础，以开发和测试针对高危室内性工作场所和场所群的地理定向降低风险干预措施。

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.