A structural HIV prevention intervention targeting high-risk women

 描述(申请人提供)：艾滋病毒流行三十年后，全世界性工作者中艾滋病毒/性传播感染的比率仍然居高不下，而美国对这一人群的研究很少。女性工作人员经历了一组独特的脆弱性，这些脆弱性与污名和不安全的工作环境等结构性因素有关。这些因素阻碍了保护性性行为和寻求艾滋病毒检测、护理和治疗。针对暗娼感染艾滋病毒的社会和结构脆弱性的艾滋病毒预防办法已在世界范围内显示出有效性。我们的目标是开发和评估以社区为基础的组合艾滋病毒预防方案的有效性，包括通过“高跟鞋”中心提供的一系列生物医学、行为和结构服务。训练有素的同伴教育者(N=20)将在异国舞蹈俱乐部和街道场地进行外展，推广中心的使用，并进行社区动员。这项研究的总体目标是通过社会凝聚力和集体行动等机制促进社区赋权，从而可持续地降低艾滋病毒风险。我们假设，解决结构性驱动因素和更直接的医疗需求，与同伴教育相结合，将导致社区赋权，并减少艾滋病毒/性传播感染的发生率和风险。这项研究的目的是：1)与对照社区(N=150)相比，研究干预措施对暗娼艾滋病毒危险行为(吸毒/无保护的性行为)和18个月内艾滋病毒/性传播感染累积发病率的影响，以及这些变化与干预暴露的关系；2)检查社会结构(例如，社会凝聚力、耻辱)和结构性脆弱性指标(例如， 财务和住房稳定性)变化，并与干预(n=200)与对照(n=150)参与者随时间的生物和行为结果相关；以及3)通过定性(例如，深度访谈)和定量(例如，对计划的适合性、可达性、促进者和障碍以及计划成本的评估)检查干预措施的实施情况 措施。为了实现这些目标，我们建议开发和评估一种理论上知情的、以社区为基础的综合干预措施，包括高跟鞋中心、培训FSW同伴教育者(N=20)和24小时危机热线。我们广泛的社区合作伙伴将在中心提供服务，从而提高可持续性。这项研究在针对美国FSWs的综合方法方面具有创新性，并满足了越来越多的要求设计和评估结构性干预措施的呼声，这是NIDA的优先事项(PA-12-281)。

 DESCRIPTION (provided by applicant): Three decades into the HIV epidemic, high HIV/STI rates persist among FSWs throughout the world, and research on this population in the U.S. is scarce. FSWs experience a unique set of vulnerabilities associated with structural factors such stigma, and unsafe work environments. These factors inhibit protective sexual behaviors and seeking of HIV testing, care, and treatment. HIV prevention approaches that address social and structural vulnerabilities to HIV infection among FSWs have demonstrated effectiveness worldwide. We aim to develop and evaluate the effectiveness of a community-based combination HIV prevention package to include a range of biomedical, behavioral, and structural services, provided through the "STILETTO" Center. Trained peer educators (N=20) will conduct outreach in exotic dance club and street venues, promote the use of the Center, and enact community mobilization. The study's overall goal is to stimulate community empowerment, through such mechanisms as social cohesion and collective action, resulting in sustainable HIV risk reduction. We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer education, will lead to community empowerment and reduce HIV/STIs incidence and risk. The study aims to: 1) examine the effects of the intervention on FSWs' HIV risk behaviors (drug use/unprotected sex), and HIV/STI cumulative incidence over 18 months in the intervention (n=200) compared to those in the comparison (N=150) communities, and how these changes are associated with intervention exposure; 2) examine how socio-structural (e.g., social cohesion, stigma) and structural vulnerability indicators (e.g., financial and housing stability) change and are associated with the biological and behavioral outcomes over time in intervention (n=200) versus comparison (n=150) participants; and to 3) examine the intervention's implementation through qualitative (e.g., in-depth interviews) and quantitative (e.g., assessment of program fit, reach, facilitators and barriers, and program costs) measures. To achieve these aims, we propose developing and evaluating a theoretically informed, community-based comprehensive intervention comprised of the STILETTO Center, training FSW peer educators (N=20), and a 24-hour crisis hotline line. Our extensive community partners will provide services at the Center, thereby increasing sustainability. The study is innovative in its comprehensive approach targeting U.S. FSWs and addresses the growing call for designing and evaluating structural interventions, a NIDA priority (PA-12-281).