A feasibility study of the HIV/STI risk environment of vulnerable women

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DESCRIPTION (provided by applicant): Women who engage in sex work are considered a key population in the transmission and acquisition of HIV and other sexually transmitted infections (STIs).1-6 Sex work is defined as the receipt of money or goods in exchange for sexual services.7 There is solid evidence that some exotic dancers explicitly sell sex and thus may be an important subpopulation of informal female sex workers.8-11 Furthermore, exotic dancing may be a gateway to the initiation or escalation of illicit drug use.8, 12, 13 We hypothesize that many women start dancing in exotic dance clubs (EDC) and, depending on the EDC environment, may begin or escalate illicit drug use and sell sex over time. There is a growing body of literature that focuses on the role of environmental factors in shaping individual-level HIV behaviors.14-17 Rhodes has developed an HIV "risk environment" framework that emphasizes the primacy of context and shifts the cause of risk from individuals to the social situations and structures in which behaviors occur.15, 16 Research has demonstrated that HIV/STI risks among sex workers are influenced by characteristics of the environments (i.e., legality of sex work, higher pay for unprotected sex) in which they sell sex.18-20 Identifying aspects of the EDC environment that promote or inhibit risk could provide new options for preventing HIV/STIs in this and other vulnerable populations. A crucial first step in this line of investigation is to devlop quantitative risk environment measures and to gather preliminary evidence that sex work and drug use increase over time due to exposure to risky EDC environments. Our study aims to develop a quantitative measurement of risk environment domains, as well as recruit, enroll, and follow a cohort of new (<6 months) exotic dancers (N=90) in Baltimore. Specifically, we aim to: 1) to develop and validate a measurement tool to characterize the risk environment of exotic dance clubs along four domains (i.e., physical, social, economic, and policy); 2) to enroll, recrui, and retain new, female exotic dancers (N=90) in low- (n=3) and high-risk (n=3) EDC environments over time in order to test feasibility for a future, larger longitudinal study. New exotic dancers will be defined as female exotic dancers who initiated dancing <6 months prior to study enrollment; and to 3) quantitatively and qualitatively explore the nature of entry and continued work in EDCs among exotic dancers, including examining the initiation and/or escalation of sexual and drug risk behaviors in this environment over a six month period. The current exploratory, feasibility study has the potential to contribute novel methods for quantifyin the risk environment, will provide insight into how to best recruit and follow-up the study population, and will provide a foundation for future observational and intervention research for this understudied yet potentially significant population.