HIV Risk among Latino Day Laborers: Structural, Social, and Individual Factors

描述(由申请人提供)：这项探索性研究(R21)针对马里兰州郊区的男性移民拉丁裔日工中的艾滋病毒风险，就在华盛顿特区外。临时工在非正式市场(通常是户外)寻找工作，或者通过临时工招聘机构寻找工作，这种情况不太常见。关于这一群体的现有研究微不足道，但有证据表明，拉丁裔临时工面临感染艾滋病毒的风险。这项研究涉及乔治华盛顿大学和马里兰之家之间的合作，后者是一个以社区为基础的组织，为拉美裔临时工提供服务。它具有创新性，因为它调查了个体特征及其对临时工所遇到的社会和结构背景下的性危险行为的影响。这项研究具有公共卫生意义，因为它将使人们了解艾滋病毒检测的风险和障碍，这是一个未得到充分服务的弱势群体，其特点是检测延迟和接受护理的时间较晚。其具体目标是：1)描述影响马里兰州华盛顿特区近郊男性、移民和拉丁裔临时工的个人、社会和结构状况；并测试人口特征、文化特征、歧视经历和生活状况对性风险行为的影响；2)检查社会和结构因素产生的条件如何影响酗酒和孤独，并探索酗酒和孤独对性风险行为的影响；以及3)检查目标人群对艾滋病毒检测的态度和障碍。将采用定性和定量相结合的方法。主要调查对象访谈(N=10)、对临时工(N=10)和为他们提供服务的女性性工作者(N=5)的深入访谈，以及与临时工的焦点小组(2个小组，8至10人参与；N=20)将详细描述临时工的社会和结构状况，并将阐明影响危险行为的多种因素和艾滋病毒检测的障碍。还将调查女性商业性工作者的使用模式和相关的性风险。将使用Audio-CASI进行定量调查(飞行员为N=20；完整样本为N=175)，以检验以下假设：1)社会和结构条件可能产生的个人特征对性危险行为的影响；2)孤独和酗酒作为此类特征影响的中介因素的作用；3)不同类型的障碍对艾滋病毒检测的重要性。由此获得的知识将有助于艾滋病毒预防工作的设计和未来的研究。它将确定可以在多个层面上解决的相关问题，包括通过针对个人的干预措施(例如，改变人们对艾滋病毒检测的态度)、影响社区的社会方案(例如，创造机会建立联系，从而减少社会孤立和孤独)，以及政府颁布的政策(例如，改善获得卫生服务的机会)。公共卫生相关性：这项探索性研究将具有公共卫生意义，因为它将检查男性、移民拉丁裔日间劳动者在其生活的社会和结构背景下的个体艾滋病毒风险行为。此外，它将使人们了解艾滋病毒检测的障碍，这是一个服务不足和弱势群体的特点，其特点是检测延迟和接受护理的时间较晚。这项研究将确定可以在多个层面上解决的相关问题，例如，通过针对个人的干预措施(例如，改变对艾滋病毒检测的态度)、影响社区的社会方案(例如，创造机会建立联系，从而减少孤立和孤独)，以及政府颁布的政策(例如，改善获得卫生服务的机会)。

DESCRIPTION (provided by applicant): This exploratory study (R21) addresses HIV risk among male, migrant Latino day laborers in suburban Maryland, just outside Washington, DC. Day laborers seek work in informal markets (typically outdoors) or, less commonly, through temporary-work staffing agencies. There is negligible extant research on this population, but there is evidence to suggest that Latino day laborers are at risk for contracting HIV. This study involves a partnership between George Washington University and Casa de Maryland, a community-based organization serving Latino day laborers. It is innovative because it investigates individual characteristics and their impact on sexual risk behavior within the social and structural context encountered by day laborers. The study has public health significance because it will result in knowledge concerning sexual risk and barriers to HIV testing in an underserved and vulnerable group characterized by delayed testing and late entry to care. The specific aims are: 1) To describe individual, social, and structural conditions that affect male, migrant, Latino day laborers in the inner Maryland suburbs of Washington, DC; and to test the impact of demographic characteristics, cultural characteristics, experiences of discrimination, and living situation on sexual risk behavior; 2) To examine ways in which conditions arising from social and structural factors influence binge drinking and loneliness, and to explore the impact of binge drinking and loneliness on sexual risk behavior; and 3) To examine attitudes toward and barriers to HIV testing in the target population. Qualitative and quantitative methods will be used. Key informant interviews (N=10), in-depth interviews with day laborers (N=10) and female sex workers who serve them (N=5), and focus groups with day laborers (2 groups with 8 to 10 participants; N=20) will provide detailed descriptions of the social and structural conditions of day laborers' lives and will illuminate the multiple factors shaping risk behavior and barriers to HIV testing. Patterns of use of female commercial sex workers and associated sexual risks will also be investigated. A quantitative survey, administered with Audio-CASI (N=20 for pilot; N=175 for full sample), will be used to test hypotheses concerning 1) the impact on sexual risk behavior of individual characteristics that may arise from social and structural conditions; 2) the role of loneliness and binge drinking as mediators of the effects of such characteristics; and 3) the importance of different types of barriers to HIV testing. The resulting knowledge will be useful for the design of HIV prevention efforts and future research. It will identify relevant conditions that could be addressed at multiple levels, including through interventions aimed at individuals (e.g., to change people's attitudes about HIV testing), social programs affecting the community (e.g., to create opportunities to build bonds and thereby lessen social isolation and loneliness), and policies enacted by government (e.g., to improve access to health services). PUBLIC HEALTH RELEVANCE: This exploratory study will have public health significance because it will examine individual HIV risk behavior of male, migrant Latino day laborers within the social and structural contexts of their lives. Moreover, it will result in knowledge concerning barriers to HIV testing in an underserved and vulnerable group characterized by delayed testing and late entry to care. This study will identify relevant conditions that could be addressed at multiple levels, e.g., through interventions aimed at individuals (e.g., to change attitudes about HIV testing), social programs affecting the community (e.g., to create opportunities to build bonds and thereby lessen isolation and loneliness), and policies enacted by government (e.g., to improve access to health services).