The HIV risk environment of high-risk women: Interaction with public safety

描述：尽管有许多共同的目标，公共卫生和公共安全系统往往不合作，因此可能最终在交叉目的工作。他们对性工作的不同反应尤其引人注目，公共卫生侧重于促进健康和减少风险，而公共安全则侧重于将性工作及其经常伴随的药物使用定罪。当人们考虑到女性性工作者（FSWs）的艾滋病风险时，更好地理解和协调这些方法的必要性是显而易见的。为了填补这一空白，本研究的目的是：1)探索在巴尔的摩市高犯罪率地区工作的巴尔的摩市警察领导层（N=15）和街道警察（N=30）的警察文化、对FSWs的态度和经验；2)在一组250名女服务员（N=250）为期12个月的调查中，研究女服务员的HIV风险行为（如无保护的性行为、使用不安全的注射方法、吸食可卡因）与警察接触的频率和类型（即言语和性骚扰、性剥削、没收安全套和注射器）之间的关系；3)在一组女工（N=250）中，在12个月的时间里，研究艾滋病毒/性传播感染的发病率和流行程度与警察遭遇的频率和类型之间的关系。在实现目标1时，我们将进行组织民族志，这是一种多方法的方法，可以深入研究警察文化，警察政策，以及领导和巡逻警察自己的态度和经验。通过目标2，我们将通过有针对性的抽样，在街头场所招募和跟踪一组fsw (N=250)，这些场所将通过二手数据分析，街道关键信息访谈和民族志绘图来确定。通过这些数据，我们将研究高风险药物和性行为（即无保护的性行为，注射毒品使用）与警察遭遇之间的关系。将在基线、3个月、6个月、9个月和12个月收集数据。该提案具有创新性，因为它回应了一个新兴的全球证据基础，该证据表明警察在FSWs的艾滋病毒/性传播感染风险行为和感染中处于中心地位1,2,9,19,20该研究结合了组织人种学、前瞻性定量研究和生物学结果，代表了美国首次努力更好地理解警察如何以及为什么在fsw中作为结构性艾滋病毒/性传播感染驱动因素发挥作用，并反过来为未来的干预奠定基础。这项研究将由一个由警察、法律、公共卫生、消防局和社区持份者组成的多界别社区谘询委员会指导。CAB和警察局长的支持将是制定源于这项工作的可持续和现实干预措施的核心。

DESCRIPTION: Despite many shared goals, public health and public safety systems often do not collaborate and therefore may end up working at cross purposes. Their divergent responses to sex work are particularly striking, with public health focusing on health promotion and risk reduction in contrast to public safety's focus on criminalization of both sex work and the substance use that so often accompanies it. The need to better understand and align these approaches is evident when one considers female sex workers' (FSWs) HIV risk. To fill this gap, study aims are to: 1) to explore police culture, attitudes of, and experiences with FSWs among Baltimore city police leadership (N=15) and street-level police (N=30) working in high crime areas in Baltimore City; 2) to examine the association between the FSWs' HIV risk behaviors (e.g., unprotected sex, unsafe injection practices use, crack use) with police encounters the frequency and type (i.e., verbal and sexual harassment, sexual exploitation, condom and syringe confiscation) of police encounters, among a cohort of FSWs (N=250) over a 12-month period of time; and 3) to examine the association between HIV/STIs incidence and prevalence with the frequency and type of police encounters among a cohort of FSWs (N=250) over a 12-month period of time. In meeting Aim 1, we will conduct organizational ethnography, a multi-method approach, which will allow for an in-depth examination of police culture, police policies, as well as attitudes and experience of leadership and patrol police in their own words. Through Aim 2, we will enroll and follow a cohort of FSWs (N=250) through targeted sampling, at street-based venues that will be identified through secondary data analysis, street key informant interviews, and ethnographic mapping. Through these data, we will examine associations between risky drug and sexual behaviors (i.e., unprotected sex, injection drug use) with police encounters over time. Data will be collected at baseline, 3-, 6-, 9-, and 12-months. The proposal is innovative in responding to an emerging, global evidence base illustrating the centrality of police in FSWs' HIV/STI risk behaviors and infection.1,2,9,19,20 The study blends organizational ethnography, prospective quantitative research, and biological outcomes and represents the first US-based effort to better understand how and why police function as a structural HIV/STI driver among FSWs, and in turn lay the foundation for future interventions. The study will be guided by a multi-sectorial community advisory board (CAB) comprised of police, legal, public health, FSW, and community stakeholders. The CAB and support of the Police Commissioner will be central to the development of sustainable and realistic interventions stemming from this work.