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

描述（由申请人提供）：本研究的总体目标是研究两个墨西哥-美国边境城市的高风险女性性工作者（FSW）及其非商业男性伴侣中的HIV、STI和相关风险行为的背景和流行病学。我们的两国团队在过去5年中收集的初步数据表明，FSW的非商业性伙伴可能是艾滋病毒/性传播感染和/或再次感染的重要驱动因素，这得到了其他国家文献的支持。在我们的环境中，FSW与其主要非商业性伙伴进行无保护性行为的可能性是其两倍多;这些伙伴中有一半有同时的伙伴关系，三分之一是注射吸毒者。建议的研究FSW合作伙伴对（二人）建立在我们现有的研究基础设施，在蒂华纳和镉。目标1：采用混合方法，研究高风险性工作者及其主要非商业性男性伴侣在伴侣关系内外的高风险性行为和药物使用行为的a）背景和B）模式;目标2：确定艾滋病毒和特定性传播感染的流行率（即，梅毒、淋病、衣原体、HSV-2）以及个人和伴侣层面上的相关因素;目标3：前瞻性地确定个人和伴侣层面上STI发病率及其归因风险的预测因素;目标4：为了确定在高危性工作者及其主要非商业男性伴侣中进行行为干预试验的可行性，在a）伴侣水平和B）个人水平上，使用混合方法。为了实现这些目标，我们将招募100名FSW合作伙伴在蒂华纳和镉。华雷斯（即，200对夫妇），他们将在基线和随访24个月时接受面谈和艾滋病毒/性传播感染检测，以解决临床和行为结果（目标2和3）。一个子集（每个城市25对夫妇）将在基线时进行深入访谈，并在随访期间进行一次深入访谈，以完善定量调查，并为解决目标1和4的混合方法分析提供信息。使用定性和定量的方法，我们将评估每个合作伙伴参与后续干预的兴趣，减员和伙伴关系的解散，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FSW及其非商业伙伴的首次前瞻性评估。我们的两国研究团队在进行这项研究方面具有独特的优势，这将为应对墨西哥-美国边境日益严重的艾滋病毒危机以及在其他资源有限的环境中减少FSW及其合作伙伴之间的艾滋病毒传播提供信息。 公共卫生相关性：拟对蒂华纳和华雷斯城的FSW-伴侣对进行的研究将达到以下目标：目标1：采用混合方法，检查a）社会背景和B）高风险FSW及其主要非商业男性伴侣之间的高风险性行为和药物使用行为模式，包括伴侣关系内外;目标2：确定艾滋病毒和特定性传播感染（即，梅毒、淋病、衣原体、HSV-2）以及个人和伴侣层面上的相关因素;目标3：前瞻性地确定个人和伴侣层面上STI发病率及其归因风险的预测因素;目标4：为了确定在高危性工作者及其主要非商业男性伴侣中进行行为干预试验的可行性，在a）伴侣水平和B）个人水平上，使用混合方法。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The proposed study of FSW-partner pairs in Tijuana and Ciudad Juarez will meet the following aims: Aim 1: To examine the a) social 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.