Concurrent Partnerships Among High-Risk Couples in the U.S.-Mexico Border Region

描述(由申请人提供)：拟议的学位论文研究项目(R36)的总体目标是在美国-墨西哥边境地区的高危、吸毒的女性性工作者(FSWs)及其非商业性、亲密的男性伴侣中，进行一项横断面混合方法研究，研究性伴侣共存(即重叠的性关系)，这是艾滋病毒和其他性传播感染(STI)流行病学中的一个重要因素。药物滥用、性工作和人口流动是该区域的特点，在该区域，包括暗娼和注射吸毒者在内的高危人群中出现了艾滋病毒/性传播感染的动态流行。尽管到目前为止，这些艾滋病毒/性传播感染的流行仍然集中在一起，但FSW-亲密伴侣二人组之间的并发可能会迅速促进艾滋病毒/性传播感染与普通人群的“桥梁”。尽管有大量关于并发性的文献，但人们对西半球资源匮乏环境中被边缘化的、吸毒的二元组并发的动机和背景知之甚少。这项拟议的论文研究试图描述高危二联体并发的社会背景(目标1)，并确定在美国-墨西哥边境地区高危性工作者(目标2)及其亲密男性伴侣(目标3)并发的特定性别的流行率和相关性。为了实现这些目标，我们将在Proyecto Parejas(R01-DA02772；PI：S.Strathdee)内使用定性和定量方法实施横断面混合方法设计，Proyecto Parejas(R01-DA02772；PI：S.Strathdee)是一个由200对高风险、吸毒的FSWs及其在提华纳和CD的亲密男性伴侣组成的现有队列。华雷斯(总共400名受试者)。为了实现目标1，我们将有目的地抽样约20名女性和约20名男性(N=40)，在现有的基线定量调查中报告最近(过去一年)的并发情况，这些调查使用联合国艾滋病规划署推荐性伴侣病史模块来衡量并发情况。我们将对这一子样本进行半结构化访谈，这将有别于父研究的数据收集，以定性地探索并发的含义和动机，包括可能促进或阻碍并发行为的社会和环境因素。然后，我们将使用紧急的定性发现来开发一个概念框架和具体的假设来指导定量分析。为了达到目标2和3，我们将使用来自整个200个二元组(N=400)的现有量化基线数据。我们将确定并发患病率，并应用多水平(即二元)Logistic回归来确定FSWs(目标2)及其亲密男性伴侣(目标3)并发的个人和关系级别的相关性。我们的二元混合方法研究设计将在一个以流行的毒品使用、商业性行为和人口流动为特征的地区提供第一次对并发性的深入调查。它还将把PI定位为药物滥用研究中具有竞争力的新调查者。研究结果将对制定以证据为基础、针对性别的干预措施至关重要，以降低吸毒性暗娼及其亲密男性伴侣中艾滋病毒/性传播感染的风险。

DESCRIPTION (provided by applicant): The overall goal of the proposed dissertation research project (R36) is to conduct a cross-sectional mixed methods study of sexual partner concurrency (i.e., overlapping sexual partnerships), an important factor in the epidemiology of HIV and other sexually transmitted infections (STIs), among dyads of high-risk, drug using female sex workers (FSWs) and their non-commercial, intimate male partners in the U.S.-Mexico border region. Substance abuse, sex work, and population mobility are features of the region, where a dynamic epidemic of HIV/STIs has emerged in high-risk populations including FSWs and injection drug users (IDUs). Although to date these HIV/STI epidemics remain concentrated, concurrency among FSW-intimate partner dyads could rapidly promote the "bridging" of HIV/STIs to the general population. Despite the vast literature on concurrency, little is known about the motivations for and contexts surrounding concurrency among marginalized, drug-using dyads in resource-poor settings in the Western Hemisphere. The proposed dissertation study seeks to characterize the social context of concurrency for high-risk dyads (Aim 1) and determine the gender-specific prevalence and correlates of concurrency among high-risk FSWs (Aim 2) and their intimate male partners (Aim 3) in the U.S.-Mexico border region. To meet these aims, we will implement a cross-sectional mixed methods design using qualitative and quantitative methods within Proyecto Parejas (R01-DA02772; PI: S. Strathdee), an existing cohort of 200 dyads of high-risk, drug-using FSWs and their intimate male partners in Tijuana and Cd. Juarez (N=400 subjects total). To meet Aim 1, we will purposively sample ~20 women and ~20 men (N=40) reporting recent (past year) concurrency in existing baseline quantitative surveys that measured concurrency using a UNAIDS-recommended sexual partner history module. We will conduct semi-structured interviews with this subsample, which will be distinct from data collection of the parent study, to qualitatively explore the meanings of and motivations for concurrency including social and environmental factors that may promote or discourage concurrency behaviors. We will then use emergent qualitative findings to develop a conceptual framework and specific hypotheses to guide quantitative analyses. To meet Aims 2 and 3, we will use existing quantitative baseline data from the entire cohort of 200 dyads (N=400). We will determine concurrency prevalence and apply multilevel (i.e., dyadic) logistic regression to identify individual- and relationship-level correlates of concurrency for FSWs (Aim 2) and their intimate male partners (Aim 3). Our dyadic, mixed methods study design will provide the first in-depth investigation of concurrency in a region characterized by prevalent drug use, commercial sex, and population mobility. It will also position the PI as a competitive new investigator in drug abuse research. Findings will be critical to the development of evidence-based, gender-specific interventions to reduce HIV/STI risk among drug-using FSWs and their intimate male partners.