Sexual Health among Low-Income Female CSWs in China

描述(申请人提供)：本研究旨在描述上海外来和非外来女性街头流浪者的性健康、同伴社交网络和社会/认知伙伴的特征，中国。上海是中国最大的货运港，也是主要的都市圈[1]。这里有500万农村向城市流动人口[2]，性传播感染发病率最高的是中国[3-6]。这项研究的结果将被用来指导未来针对移民和非移民街头步行者的纵向性健康风险降低研究的发展。在我们的初步研究中，与来自其他场所的性工作者相比，处于性工作等级最底层[13-15]的“街头步行者”(Sw)据报道年龄较大，受教育程度较低，工资较低，在性交易中使用保护措施的可能性较小。研究人员和公共卫生机构也承认，他们极难接触到他们[7-9]。对他们的性健康(如性传播感染的流行、无保护措施和其他高危性行为)以及他们如何与其工作性质(如同伴社交网络、群体规范、基于性别的关系权力和社会提供)相关联，知之甚少。此外，目前还不清楚流动人口和非流动人口的街头步行者之间的性行为有何不同。必须制定针对这一高危人群的干预措施。要做到这一点，关键是要建立关于风险决定因素和发生风险的背景的可靠和有效的数据。这是这项拟议研究的首要目标。在目前的应用中，我们将首次使用受访者驱动抽样(RDS)来招募中国的女性街头流浪者(200名流动人口对100名非流动人口)。具体目的是：(1)描述和比较流动人口和非流动人口街头流浪者之间无保护的性行为和性传播感染(衣原体、淋病、梅毒、单纯疱疹病毒和乙肝)的流行情况；(2)基于形成性定性访谈和RDS从属指数，描述和比较流动人口和非流动人口街头流浪者的同伴社会网络特征；以及(3)在流动人口和非流动街头流浪者群体中，测试将无保护的性行为和性传播感染流行率与个人层面的社会认知因素(例如，感知的性传播感染风险、持续使用避孕套的自我效能、使用避孕套的结果预期)和背景社会文化因素(例如，基于性别的性关系权力、同伴社会网络、群体规范)联系起来的工作概念模型。这项拟议的研究具有重要意义，因为它关注的是日益增长的高危和未得到充分研究的人群：中国的街头流浪者。该项目在利用RDS在这个难以接触到的人口中进行招募方面具有创新性，并在评估同行社交网络及其与移徙和非移徙街头步行者的性健康之间的关联方面具有创新性。这项拟议研究的结果将对于性健康促进和疾病预防/干预产生深远的影响，特别是在中国和其他地方以街头流浪者为目标的“同伴教育”模式。 公共卫生相关性：这项为期两年的研究的主要目标是特征性健康，同伴社会网络，认知和社会交往的性健康在上海流动和非流动女性街头流浪者，中国。上海是中国最大的都市区之一，也是中国所有城市中流动人口最多、性病发病率最高的城市。这项研究的结果将被用来指导未来针对街头步行者的纵向性健康风险降低研究的发展。

DESCRIPTION (provided by applicant): The study aimed to characterize the sexual health, peer social networks, and social/cognitive associates of sexual health among migrant and non-migrant female Street Walkers (SW) in Shanghai, China. Shanghai is China's largest cargo port and a major metropolitan area [1]. It has 5 million rural-to-urban migrant population [2] and the highest sexually transmitted infection (STI) incidence rate [3-6] in China. The findings from this study will be used to guide the development of a future longitudinal sexual health risk reduction study targeting migrant and non-migrant street walkers. "Street walkers"(SW), who are at the bottom of the sex work hierarchy[13-15], were reported to be older, less educated, lower-paid, and less likely to use protection in sexual transactions compared to sex worker from other venues in our pilot study. They are also acknowledged by researchers and public health agencies to be extremely difficult to reach [7-9].Little is known about their sexual health (e.g. prevalence of STI, unprotected and other high-risk sexual behavior) and how they associated with the nature of their work (e.g., peer social network, group norm, gender-based relational power, and social provision). In addition, it is not clear how sexual practices differ between migrant and non-migrant street walkers. Interventions must be developed to target this high-risk population. To do so, it is critical to establish reliable and valid data regarding their determinants of risk and the context in which this occurs. It is the overarching goal of this proposed study. In the current application we Respondent Driven Sampling (RDS) will be used for the first time to recruit female street walkers in China (200 migrants vs. 100 non-migrants). The specific aims are to: (1) describe and compare the prevalence of unprotected sexual practices and STIs (Chlamydia, gonorrhea, syphilis, HSV-2, and HBV) between migrant and non-migrant street walkers; (2) describe and compare the characteristics of peer social networks of migrant and non-migrant street walkers based on formative qualitative interviews and RDS affiliation indices; and (3) test a working conceptual model relating unprotected sexual practices and STI prevalence to individual level social cognitive factors (e.g., perceived STI risk, self efficacy of consistent condom use, outcome expectancy of condom use) and contextual social cultural factors (e.g, gender-based sexual relationship power, peer social network, group norms) in the migrant and non-migrant street walker populations. The proposed study is significant as it focuses on a growing high-risk and under-studied population: street walkers in China. The project is innovative in its use of RDS for recruitment in this hard to reach population and in its assessment of peer social networks and their association with sexual health among both migrant and non-migrant street walkers. Findings from the proposed study will have far reaching implications for sexual health promotion and disease prevention / interventions, particularly those using "peer education" models, to target street walkers in China and elsewhere. PUBLIC HEALTH RELEVANCE: The primary goal of this 2-year study is to characterize the sexual health, peer social networks, and cognitive and social associates of sexual health among migrant and non-migrant female Street Walkers (SW) in Shanghai, China. Shanghai is one of the largest metropolitan areas in China and has the largest migrant population and the highest STI incidence rate of all Chinese cities. The findings from this study will be used to guide the development of a future longitudinal sexual health risk reduction study targeting street walkers.