Impact of Structural Policy Reform on HIV/STI Risk and Access to Care among SWs

结构性政策改革对社会工作者的艾滋病毒/性传播感染风险和获得护理的影响

• 批准号: 8922486
• 负责人: Kate Shannon
• 金额: $ 42.59万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-03-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8922486
• 关键词: Address; Affect; Attention; Biological; Boston; Canada; Caring; Cities; Client; Communities; Country; Court Decisions; Criminal Justice; Criminal Law; Data; Databases; Drug usage; Employee Strikes; Epidemic; Evaluation; Female; Funding; Goals; Government; Grant; HIV; HIV Infections; HIV Seropositivity; HIV/STD; Harm Reduction; Health; Health Insurance; Health Professional; Health Services Accessibility; Healthcare; Homicide; Imprisonment; Incidence; Injection of therapeutic agent; Institutes; International; Intervention; Interview; Laws; Left; Legal; Link; Location; Longitudinal Studies; Maps; Measures; Medical; Methods; Modeling; National Institute of Drug Abuse; Natural experiment; Needle Sharing; Neighborhoods; New Jersey; North America; Outcome; Pattern; Persons; Pharmaceutical Preparations; Police; Policies; Population; Prostitution; Questionnaires; RNA; Recruitment Activity; Research; Risk; Role; Safety; Scientist; Serologic tests; Sister; Site; Statutes and Laws; Surveys; Testing; Time; United States National Institutes of Health; Violence; Viral Load result; Woman; Women' s Health; Work; administrative database; antiretroviral therapy; base; cohesion; cohort; collaborative environment; community organizations; condoms; court; drug market; evidence base; meetings; mortality; programs; public health relevance; research study; seropositive; sex; sex risk; sexual HIV transmission; sexual violence; social; social stigma; transmission process; uptake

 DESCRIPTION (provided by applicant): The goal of this competing renewal is to study the impact of sex work law reform on mitigating or potentiating HIV/STI risks and access to HIV/STI-related care among female SWs. The Canadian government has recently introduced new legislation (Bill C-36) that will criminalize the purchase of sex (clients) and anyone who economically profits from prostitution (e.g., third parties, such brothel managers) while leaving the selling of sex as legal. This approach of criminalizing clients and third parties, but not SWs, often referred to as the "Nordic model," has received increasing international attention over the last year, with similar laws/policies introduced in the EU, UK, and a growing number of US cities, despite a complete dearth of research on its intended and unintended impacts. Scientists, health professionals, and community have expressed strong concern that this law will escalate structural HIV/STI risks through heightened stigma and reduced social cohesion among SWs, displacement of SWs to hidden and unsafe venues to avoid police persecution, and increased rates and spatial clustering of violence and homicide. There is also increasing concern that police will use new means to harass and target SWs, including administrative laws (e.g., public nuisance, loitering), drug offenses, and court-mandated drug treatment for SWs who inject drugs (SW-PWIDs), which may further elevate sexual- and drug-related HIV/STI risks. Whether and how these new prostitution laws will affect structural HIV/STI risks and sexual- and drug-related harms for SWs will be important for international and US community and global policy. Through support from an R01, our team has assembled, recruited, and followed a large community-based cohort of street and off-street female SWs across Vancouver since 2005, known as the AESHA cohort (>90% retention). Vancouver is an ideal location for this research for several reasons: the imminent policy reform opportunity; site of one of the only longitudinal cohorts of SWs in North America; progressive harm reduction programs (e.g., supervised injection facilities) for SW- PWID; site of government-sponsored `seek, test, treat and retain' HIV efforts; and universal health coverage that allows us to link survey and biological data with administrative databases, permitting assessment of health care barriers free of the confounding effects of medical health insurance. Given the large number of countries, as well as US cities, contemplating legislative reform around sex work in the absence of empirical data, this study allows an unprecedented opportunity to evaluate a structural intervention of sex work law reform as a naturally-occurring experiment on HIV/STI risks and other health outcomes among SWs. The evaluation of structural interventions is rare and a high priority in the 2014 Trans-NIH Plan for HIV Research.

 描述（由申请人提供）：这一竞争性更新的目标是研究性工作法律改革对减轻或加强艾滋病毒/性传播感染风险和获得艾滋病毒/性传播感染相关护理的影响。加拿大政府最近提出了新的立法（C-36法案），将买春（嫖客）和任何从卖淫中获得经济利益的人（例如，第三方，如妓院经理），同时将性交易视为法律的。这种将客户和第三方而不是SW定为刑事犯罪的方法， 通常被称为“北欧模式”，在过去的一年里受到了越来越多的国际关注，欧盟，英国和越来越多的美国城市引入了类似的法律/政策，尽管完全缺乏对其预期和非预期影响的研究。科学家、卫生专业人员和社区都表示强烈关切，这项法律将加剧艾滋病毒/性传播感染的结构性风险，因为这会加剧对性工作者的污名化，降低社会凝聚力，使性工作者流离失所到隐蔽和不安全的场所，以避免警察的迫害，并增加暴力和杀人的发生率和空间聚集性。人们也越来越担心，警方将使用新的手段来骚扰和针对社会工作者，包括行政法律（例如，公共滋扰，游荡），毒品犯罪，以及法院强制注射毒品的SW（SW-PWID）的药物治疗，这可能会进一步提高性和毒品相关的艾滋病毒/性传播疾病风险。这些新的卖淫法是否以及如何影响结构性艾滋病毒/性传播感染风险以及性和毒品相关的伤害，对于国际和美国社区以及全球政策都很重要。 通过R 01的支持，我们的团队自2005年以来在温哥华聚集、招募并跟踪了一个大型的社区街头和非街头女性SW队列，称为AESHA队列（>90%保留率）。温哥华是这项研究的理想地点，原因有几个：即将到来的政策改革机会;北美唯一的SW纵向队列之一;逐步减少危害的计划（例如，受监督的注射设施）;政府赞助的“寻找、测试、治疗和保留”艾滋病毒的场所 努力;以及全民健康保险，使我们能够将调查和生物数据与行政数据库联系起来，从而能够在不受医疗健康保险混淆影响的情况下评估保健障碍。鉴于大量的国家，以及美国的城市，考虑立法改革围绕性工作的经验数据的情况下，这项研究允许一个前所未有的机会来评估性工作的法律改革作为一个自然发生的实验艾滋病毒/性传播疾病的风险和其他健康结果之间的SW的结构性干预。对结构性干预措施的评估是罕见的，也是2014年跨NIH艾滋病毒研究计划的高度优先事项。