Proyecto Parejas: HIV/STI Risks among FSWs and their Non-Commercial Partners

这项研究的总体目标是研究艾滋病毒、性传播感染和相关风险的背景和流行病学。 墨西哥两个高危女性性工作者(FSWs)及其非商业性伴侣的行为 美国边境城市。我们的两国团队在过去5年收集的初步数据表明，FSWs 非商业伙伴可能是艾滋病毒/性传播感染和/或他们再次感染的重要驱动因素，这是 得到了其他国家文学作品的支持。在我们的环境中，性服务工作者参与的可能性是 与主要的非商业性伴侣发生无保护措施的性行为；这些伴侣中有一半同时存在伴侣关系 三分之一是注射吸毒者。FSW-Partner Pair(DYAD)的拟议研究建立在我们现有研究的基础上 提华纳和CD的基础设施。华雷斯实现以下目标：目标1：审查a)背景和b) 高危暗娼及其主要非暗娼的高危性行为和吸毒行为模式 在合伙企业内部和外部使用混合方法的商业男性合伙人；目标 2：确定艾滋病毒和特定的性传播疾病(即梅毒、淋病、衣原体、单纯疱疹病毒2型)的流行情况 个人和伙伴层面的关联；目标3：前瞻性地确定性传播感染的预测因素 个人和伙伴一级的发病率及其可归因性风险；目标4：确定 在高危暗娼及其主要非商业性男伴中开展行为干预试验 在a)合作伙伴一级和b)个人一级，使用混合方法。为了实现这些目标，我们将招聘100名员工 FSW-提华纳和CD中的合作伙伴二元组。华雷斯(即200对夫妇)，他们将接受采访和 在基线和24个月的随访中进行艾滋病毒/性传播感染检测，以解决临床和行为结果 (目标2和3)。一个子组(每个城市25对夫妇)将在基线和年内接受一次深入访谈 采取后续行动，完善量化调查，并采用混合方法进行分析，以解决目标1和4。 使用定性和定量的方法，我们将评估每个合作伙伴对参与 随后的干预、自然减员和伙伴关系解散，以及干预的潜在障碍，如 亲密伴侣暴力(目标4)。据我们所知，这项拟议的研究是对 FSWs及其非商业性合作伙伴。我们的两国研究团队在这方面具有得天独厚的优势 这项研究将为应对墨西哥和美国边境日益严重的艾滋病毒危机提供信息，并努力遏制 在其他资源有限的情况下，性服务工作者及其伴侣之间的艾滋病毒传播。

The overall goal of this study is to study the context and epidemiology of HIV, STIs and associated risk behaviors among high risk female sex workers (FSWs) and their non-commercial male partners in two Mexico- US border cities. Preliminary data collected by our binational team over the past 5 years suggest that FSWs' non-commercial partners may be significant drivers of HIV/STI acquisition and/or their re-infection, which is supported by literature in other countries. FSWs in our setting are more than twice as likely to engage in unprotected sex with their main non-commercial partner; half of these partners have concurrent partnerships and one third are IDUs. The proposed study of FSW-partner pairs (dyads) builds on our existing research infrastructure in Tijuana and Cd. Juarez to meet the following aims: Aim 1: To examine the a) context and b) patterns of high risk sexual and substance using behaviors among high risk FSWs and their main non- commercial male partners, both within and outside of the partnerships, using a mixed-methods approach; Aim 2: To determine prevalence of HIV and specific STIs (i.e., syphilis, gonorrhea, Chlamydia, HSV-2) and associated correlates at the individual and partner level; Aim 3: To prospectively identify predictors of STI incidence and their attributable risks at the individual and partner level; Aim 4: To determine the feasibility of conducting a behavioral intervention trial among high risk FSWs and their main non-commercial male partner at the a) partner level and b) individual level, using mixed methods. To meet these aims, we will recruit 100 FSW-partner dyads in both Tijuana and Cd. Juarez (i.e., 200 couples), who will undergo interviews and HIV/STI testing at baseline and follow-up for 24 months to address both clinical and behavioral outcomes (Aims 2 and 3). A subset (25 couples per city) will undergo in-depth interviews at baseline and once during follow-up to refine the quantitative survey, and inform a mixed methods analysis to address Aims 1 and 4. Using qualitative and quantitative methods, we will assess each partner's interest in participating in a subsequent intervention, attrition and partnership dissolution, and potential barriers to interventions such as intimate partner violence (Aim 4). To our knowledge, the proposed study is the first prospective evaluation of FSWs and their non-commercial partners. Our binational research team is uniquely positioned to conduct this study, which will inform the response to the growing HIV crisis on the Mexico-US border and efforts to curtail HIV transmission among FSWs and their partners in other resource-constrained settings.