Migration, Tourism and the HIV-drug use Syndemic in the Dominican Republic

描述（由申请人提供）：加勒比地区是继撒哈拉以南非洲之后世界上艾滋病毒流行率第二高的地区，也是受非法药物使用和毒品贩运影响最严重的地区之一。本研究以多明尼加共和国男性工作、移民、性与毒品使用行为的改变为重点，探讨男性移民的HIV风险与毒品使用与(1)移民模式和(2)旅游区的社会环境之间的关系。我们通过旅游生态的概念将当代人口变化与艾滋病毒和吸毒做法联系起来，旅游生态是指地理受限的地区，其中假设有五种生态特征（社会孤立；社会耻辱；商业规范；旅游逃避主义；毒品和酒精供应）有助于高风险行为。我们的研究从根本上依赖于一个长期存在的多部门社区咨询委员会，该委员会包括私人旅游代表、政府、公共卫生官员和民间社会。数据收集包括：(1)对两个沿海旅游区系统选择的36名男性农民工进行半结构化访谈（每个受试者两次访谈= 72次）；(2)基于Arc-GIS的两个旅游区民族志制图与空间分析；(3)在两个研究点对400名男性农民工进行横断面调查；(4)对40名男性旅游外来工进行了试点干预。本研究在三个关键方面为公众健康知识和健康促进作出贡献。首先，它确定了旅游区中最重要的因素

DESCRIPTION (provided by applicant): The Caribbean region has the second highest prevalence rates of HIV in the world following sub-Saharan Africa and is one of the region's most affected by illicit drug use and drug trafficking. Focusing on men's changing work, migration, and sexual and drug use behavior in the Dominican Republic, the proposed mixed- methods collaborative study examines how HIV risk and drug use among migrant men are related to (1) patterns of migration and (2) the social environments of tourism areas. We relate contemporary demographic changes to HIV and drug use practices through the notion of tourism ecologies - geographically constrained areas in which five ecological features (social isolation; social stigma; business norms; touristic escapism; and drug and alcohol availability) are hypothesized to contribute to high risk behaviors. Our research relies fundamentally on a long-standing multisectoral Community Advisory Board involving private tourism representatives, government, public health officials, and civil society. Data collection consists o: (1) semi- structured interviews with 36 systematically selected male migrant workers in two coastal tourism areas (two interviews per subject = 72 sessions); (2) ethnographic mapping and spatial analysis using Arc-GIS in two tourism areas; (3) a cross-sectional survey with 400 male migrant workers in two research sites; and (4) the implementation of a pilot intervention with 40 migrant male tourism workers. This study contributes to public health knowledge and health promotion in three key ways. First, it identifies the factors in tourism areas that most contribute to HIV risk and drug use, contributing to the development and piloting of an evidence-based intervention. Second, it draws on an extensive literature to systematically analyze the health effects of tourism environments in high-risk settings for HIV and drug use. Finally, it incorporate a participatory process to research that will strengthen local relevance, research translation, and the impact on health policies and programs.