Social and structural context of HIV/STI risk among FSWs

描述(申请人提供)：本申请的目的是使用社会流行病学方法，前瞻性地评估社会、环境和结构因素对性服务工作者的性和毒品风险模式以及艾滋病毒和性传播感染(STI)发病率的影响，并评估随后针对公共场所(如酒吧、街道)性服务工作者的艾滋病毒/性传播感染干预措施的可行性。尽管越来越多的证据表明，针对暗娼的环境结构性艾滋病毒/性传播感染干预措施是有效的，但这项研究主要来自发展中国家和机构场所，关于北美暗娼中艾滋病毒/性传播感染风险的社会和结构性背景的预期数据有限。鉴于最近的报告表明，在许多北美环境中，街头涉案人群从注射到性驱动的艾滋病毒流行在时间上发生了转变，因此迫切需要更多关于促进和制约伴侣一级的性和毒品风险模式以及艾滋病毒/性传播感染获得的背景因素的前瞻性数据。加拿大温哥华非常适合这项拟议的研究，原因有几个。首先，由于性工作的准刑事化性质和大的非正式容忍区，我们处于独特的地位，可以评估性工作者中艾滋病毒/性传播感染风险的背景，这在美国大多数城市目前是不可行的。其次，与FSW社区分散的许多城市环境不同，加拿大目前性工作的社会和法律背景，我们利用社区FSW对这一应用的强大支持的能力，以及目前作为准妓院合法运营的新支持性住房模式，显示出重大创新和后续干预的强大潜力，源于本研究的结果。在此，我们建议建立一个开放的前瞻性队列，由500名在公共场所工作的活跃性工作者组成，包括访谈管理的问卷和基线的艾滋病毒/性传播感染筛查，并在五年内每月随访6次。据我们所知，这项研究是北美第一批以公共场所为基础的性工作的前瞻性研究之一，因此，我们将处于独特的地位，可以评估性工作者在性伴侣层面的风险和艾滋病毒/性传播感染感染的风险环境和时间趋势。这项研究将解决北美艾滋病毒/性传播感染预防能力面临的紧迫挑战的几个核心问题，并将直接评估后续干预措施的可行性，这对其他发达国家的环境至关重要。 公共卫生相关性：虽然北美许多城市越来越担心从注射到性驱动的艾滋病毒流行的时间转变，但对更广泛的风险环境以及性工作者中艾滋病毒和性传播感染(STI)发病率的前瞻性评估有限。利用社会流行病学方法，这项研究将通过评估物质和社会环境、性别不平等和结构性因素对性伴侣层面的性和毒品风险模式以及艾滋病毒/性传播感染感染的影响，在500名开放的性工作者队列中解决这一差距。

DESCRIPTION (provided by applicant): The purpose of this application is to use social epidemiological methods to prospectively evaluate the impact of social, environmental, and structural factors on partner-level sexual and drug risk patterns and HIV and sexually transmitted infection (STI) incidence among FSWs and to assess the feasibility of a subsequent HIV/STI intervention targeting FSWs in public place-based settings (e.g. bars, streets). Despite growing evidence of the effectiveness of environmental-structural HIV/STI interventions targeting FSWs, this research has been largely derived from developing country settings and establishment-based venues, and there is limited prospective data on the social and structural context of HIV/STI risk among FSWs in North America. Given recent reports suggest a temporal shift from an injection to a sexually-driven HIV epidemic among street-involved populations in many North American settings, there is a crucial need for more prospective data on the contextual factors promoting and constraining partner-level sexual and drug risk patterns and HIV/STI acquisition. Vancouver, Canada is ideally suited for the proposed study for several reasons. First, due to the quasi-criminalized nature of sex work and large informal tolerance zones, we are in a unique position to evaluate the context of HIV/STI risk among FSWs, not currently feasible in most US cities. Second, unlike many urban environments where the FSW community is fragmented, the current social and legal context of sex work in Canada, our ability to harness strong community FSW support for this application, and new supportive housing models currently operating legally as quasi-brothels demonstrate significant innovation and strong potential for a subsequent intervention stemming from the results of this research. Herein we propose to create an open prospective cohort of 500 active FSWs working in public place-based settings, including interview administered questionnaires and HIV/STI screening at baseline and 6monthly follow-up over a five year period. To our knowledge this study is among the first prospective studies of public place-based sex work in North America and as such, we will be uniquely positioned to evaluate the risk environment and temporal trends in partner-level risks and HIV/STI acquisition among FSWs. This research will address several questions central to the urgent challenges facing HIV/STI prevention capacity in North America and will directly assess the feasibility of a subsequent intervention that will be of critical importance to other developed country settings. PUBLIC HEALTH RELEVANCE: While there is growing concern in many North American cities of a temporal shift from an injection to a sexually-driven HIV epidemic, there has been limited prospective evaluation of the broader risk environment and HIV and sexually transmitted infection (STI) incidence among FSWs. Using social epidemiological methods, this research will address this gap by evaluating the impact of the physical and social environment, gender inequities, and structural factors on partner-level sexual and drug risk patterns and HIV/STI acquisition among an open cohort of 500 FSWs.