Social and structural context of HIV/STI risk among FSWs

描述（由申请人提供）：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伴侣层面的性和药物风险模式以及fsw中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）的fsw进行艾滋病毒/性传播感染干预的可行性。尽管越来越多的证据表明，针对性服务场所的环境-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的环境和基于机构的场所，而且关于北美性服务场所艾滋病毒/性传播感染风险的社会和结构背景的前瞻性数据有限。鉴于最近的报告表明，在许多北美环境中，街头人群中的艾滋病毒流行从注射到性驱动的时间转变，迫切需要更多关于促进和限制伴侣层面的性和药物风险模式以及艾滋病毒/性传播感染的背景因素的前瞻性数据。由于几个原因，加拿大温哥华非常适合进行拟议的研究。首先，由于性工作的准犯罪性质和广泛的非正式容忍区，我们处于独特的位置来评估FSWs中艾滋病毒/性传播感染风险的背景，目前在大多数美国城市都不可行。其次，与许多城市环境中FSW社区是分散的不同，目前加拿大性工作的社会和法律背景，我们利用强大的社区FSW支持这一应用的能力，以及目前合法经营的准妓院的新支持性住房模式，都表明了重大的创新和后续干预的巨大潜力，这些都源于本研究的结果。在此，我们建议建立一个开放的前瞻性队列，包括500名在公共场所工作的在职女服务员，在基线时进行访谈问卷和艾滋病毒/性传播感染筛查，并在5年期间进行6个月的随访。据我们所知，这项研究是北美公共场所性工作的首批前瞻性研究之一，因此，我们将独特地评估fsw中伴侣层面风险和艾滋病毒/性传播感染的风险环境和时间趋势。这项研究将解决北美艾滋病/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。

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.