Venue-level Risks for HIV/STI among Male Clients of FSWs in Tijuana, Mexico

描述（由申请人提供）：本指导研究科学家发展奖（K01）的目的是三重的。这个奖项将使我能够：1)学习三种新的技能：定量和混合方法；多级建模;并将定性数据与先进的定量建模数据相结合；2)在新的文化和环境背景下（美国/墨西哥边境）扩大我对物质使用和物质使用者中艾滋病毒的理解；3)帮助我过渡到加州大学圣地亚哥分校，成为一名由美国国立卫生研究院资助的富有成效的独立研究员。培训目标将通过具体的讲习班和课程、实际操作的研究项目以及培训委员会的一对一指导来实现，培训委员会由以下领域的专家组成：在易受感染的物质使用人群中进行艾滋病毒预防研究、定性和混合方法研究、多层次建模、伦理和国际背景下（特别是美国/墨西哥边境地区）的药物使用流行病学研究。研究目的将通过对墨西哥提华纳性工作环境的社会和结构方面进行一项混合方法研究来实现，该环境影响了性工作场所男性客户的艾滋病毒风险。该研究将作为现有NIH/ nida资助的R01， DA029008（“墨西哥蒂华纳女性性工作者男性客户的安全性干预”，又名Hombre Seguro， PI: Thomas Patterson）的独立附属项目进行，以利用该项目所代表的基础设施和专业知识。美国/墨西哥边境正在经历一场迅速蔓延的艾滋病疫情，集中在高危人群中，如FSW、男性客户和吸毒者。虽然研究人员长期以来一直将混合方法应用于艾滋病毒/性传播感染的预防，但很少有研究人员将从定性方法中收集到的丰富信息与先进的统计方法（如多层次或分层线性建模）相结合。此外，研究人员还没有利用混合方法来提供一个细致入微的上下文理解，即哪些亚群体能从降低风险的干预措施中受益，哪些不能，以及为什么和如何受益。拟议的研究将使我能够应用新获得的定性和混合方法技能，并整合定性和多层次建模数据，以探索性工作场所中与FSW发生性行为的背景下物质使用的风险环境因素。这项工作将在高危人群中进行（在蒂华纳，女性性工作者的艾滋病毒感染率为6%，男性为5%）。拟议研究的结果对于制定针对边境地区和其他国际环境中有感染艾滋病毒风险的物质使用人群的多层次干预措施，以及发展将先进的定量技术与定性方法结合起来的未来混合方法研究，将至关重要。此外，发展定性和混合方法的技能，以及多层次建模，将使我成为物质使用和性工作领域少数拥有这种技能的混合方法研究人员之一，也是全球公共卫生司和加州大学圣地亚哥分校唯一的研究人员。

DESCRIPTION (provided by applicant): The purpose of this Mentored Research Scientist Development Award (K01) is threefold. This award will allow me to: 1) learn three new skill sets: quantitative and mixed methodologies; multilevel modeling; and the integration of qualitative data and advanced quantitative modeling data; 2) broaden my understanding of substance use and HIV among substance users in a new cultural and environmental context (the US/Mexico border); and 3) facilitate my transition to becoming a productive NIH-funded independent investigator at the University of California San Diego. The training aims will be accomplished through a combination of specific workshops and coursework, a hands-on research project, and one-on-one mentoring with a Training Committee comprised of experts in the areas of HIV prevention research among vulnerable substance using populations, qualitative and mixed methods research, multilevel modeling, ethics, and drug use epidemiology research in international contexts (and specifically the US/Mexico border region). The research aims will be accomplished by conducting a mixed-methods study of social and structural aspects of sex work environments influencing HIV risk among male clients of FSW in Tijuana, Mexico. The research will be conducted as an independent adjunct to an existing NIH/NIDA-funded R01, DA029008 ("Safer Sex Intervention for Male Clients of Female Sex Workers in Tijuana, Mexico" aka Hombre Seguro, PI: Thomas Patterson), in order to capitalize on the infrastructure and expertise represented by that project. The US/Mexico border is experiencing a burgeoning HIV epidemic, concentrated among high-risk groups such as FSW, male clients, and drug users. While researchers have long applied mixed methods to HIV/STI prevention, few researchers have integrated rich information gleaned from qualitative methods with advanced statistical methods like multilevel, or hierarchical linear modeling. Further, researchers have yet to utilize mixed methods to provide a nuanced, contextual understanding of which sub-groups do and do not benefit from risk reduction interventions, as well as why and how. The proposed research will allow me to apply newly acquired skills in qualitative and mixed methods and integrating qualitative and multilevel modeling data to explore risk environments factors surrounding substance use in the context of sex with FSW in sex work venues. This work will be conducted in a particularly high-risk population (in Tijuana, HIV prevalence among female sex workers is 6% and 5% for male clients). Findings from the proposed research will be critical for developing multi-level interventions for substance using populations at risk for HIV in border regions and other international settings, and for the development of future mixed methods research integrating advanced quantitative techniques with qualitative approaches in HIV prevention. Further, developing skills in qualitative and mixed methods, and multilevel modeling will uniquely position me as one of only a handful of mixed-methods researchers in the field of substance use and sex work possessing such skills, and the only one in the Division of Global Public Health and the University of California San Diego.