Training in Drug Abuse & HIV Prevention for Female & Transgender Sex Workers

描述(申请人提供)：马来西亚的艾滋病毒流行，历史上是由注射毒品的男性(PWID)推动的，在过去20年里已经转变为一种普遍的流行病，在药物滥用和性传播之间架起了桥梁。在此期间，女性在新的艾滋病毒感染中所占的比例越来越大(从1990年的1%上升到2011年的25%)，这主要归因于性传播。变性人妇女在该地区也面临着日益沉重的艾滋病毒负担，最近的证据表明，她们是全球风险最高的亚群之一。性工作和频繁同时发生的药物滥用是女性和变性人女性的主要风险因素，特别是在马来西亚，它已经成为性旅游的主要目的地。尽管国际机构(世卫组织、毒品和犯罪问题办公室、艾滋病规划署)建议采取创新的综合办法来预防艾滋病毒和药物滥用，特别是在妇女中，但马来西亚乃至整个东南亚的吸毒率严重不足。需要新的方法来解决女性和变性性性工作者(F/TGSWs)中性工作和药物滥用的复杂共同问题。这里提出的指导性项目通过进行两项形成性研究来解决这一需求。第一项研究将评估马来西亚巴生谷性服务工作者中艾滋病毒和性传播感染的流行率，评估性和毒品危险行为，并确定预防艾滋病毒和药物使用的行为和生物医学方法的可行性。第二项研究将在第一项研究的基础上，通过采用行为和生物医学干预措施，解决该地区性/TGSWs中共同发生的性和毒品危险行为。这些项目的调查结果将有助于更好地了解目标人群中的艾滋病毒和药物滥用危险行为，并建立必要的知识，以制定解决这些问题的创新办法。由于他在性别和妇女研究方面的深厚背景，他在公共卫生领域的研究效率，以及他在马来西亚背景下的研究经验，这位候选人是唯一能够胜任这项工作的人。在这项提议的五年中，他将实现他的职业目标和职业目标：1)发展必要的研究方法方面的专业知识，以设计、实施和调整艾滋病毒降低风险干预措施，并最终在马来西亚的TGW和FSWs中进行与艾滋病毒和性传播感染预防相关的临床试验；2)获得干预措施制定、适应、测试、实施和传播方面的经验，以解决艾滋病毒预防和治疗服务的性别障碍；以及3)在以患者为导向的研究中发展一条独立的职业道路，重点关注艾滋病毒与妇女健康、性别和药物滥用与预防之间的关系。为了实现这些目标，Wickersham博士组建了一支由艾滋病毒、药物滥用、流行病学以及行为和生物医学干预科学领域的杰出领导者组成的团队。在他们的指导下，他将完成相关课程，参加研讨会，并进行研究，以应用必要的技能，在马来西亚背景下成为预防女性和变性女性性工作者艾滋病毒和药物滥用的独立调查员。

DESCRIPTION (provided by applicant): Malaysia's HIV epidemic, historically driven by male people who inject drugs (PWIDs), has transitioned over the last two decades to a generalized epidemic with bridges between substance abuse and sexual transmission. During this period, females have accounted for a growing proportion of new HIV infections (from 1% in 1990 to 25% in 2011), which are overwhelmingly attributed to sexual transmission. Transgender women have also faced a growing HIV burden in the region, with recent evidence suggesting they are one of the highest at-risk subpopulations globally. Sex work and the frequent co-occurrence of substance abuse is a major risk factor for both females and transgender women, especially in Malaysia, which has become a major destination for sex tourism. Despite recommendations by international agencies (WHO, UNODC, UNAIDS) to implement innovative, combination approaches to HIV and substance abuse prevention, especially among women, uptake in Malaysia, and Southeast Asia generally, has been woefully inadequate. Novel approaches to addressing the complex syndemic of sex work and substance abuse among female and transgender sex workers (F/TGSWs) are in demand. The mentored projects proposed here address this need through the conduct of two formative research studies. The first will estimate the prevalence of HIV and STIs among F/TGSWs in Malaysia's Klang Valley, assess sexual and drug risk behaviors, and determine feasibility of behavioral and biomedical approaches to HIV and substance use prevention. The second study will build on the first by adapting behavioral and biomedical interventions to address co-occurring sexual and drug risk behaviors among F/TGSWs in the region. Findings from these projects will contribute to a greater understanding of HIV and substance abuse risk behaviors among the target population and establish the knowledge necessary to develop innovative approaches to addressing them. The candidate, Dr. Wickersham, is uniquely poised to perform this work because of his strong background in gender and women's studies, his research productivity in the area of public health, and his experience with research in the Malaysian context. Over the five years of this proposal, he will achieve his career goals and professional objectives to: 1) develop expertise in research methods necessary to design, perform, and adapt HIV risk reduction interventions and eventually conduct clinical trials relating to HIV and STI prevention among TGW and FSWs in Malaysia; 2) gain experience in intervention development, adaptation, testing, implementation, and dissemination that will address gender-specific barriers to HIV prevention and treatment services; and 3) develop an independent career path in patient-oriented research focused on the interface between HIV, women's health, gender, and substance abuse and prevention. To achieve these goals, Dr. Wickersham has assembled a team of outstanding leaders in the fields of HIV, substance abuse, epidemiology, and behavioral and biomedical intervention science. Under their guidance, he will complete relevant coursework, attend seminars, and conduct research to apply the skills necessary to become an independent investigator in HIV and substance abuse prevention among female and transgender women sex workers in the Malaysian context.