The HIV risk environment of high-risk women: Interaction with public safety

 描述：尽管有许多共同的目标，但公共卫生和公共安全系统往往不合作，因此可能最终会以不同的目的工作。他们对性工作的不同反应尤其引人注目，公共卫生关注的是促进健康和降低风险，而公共安全则侧重于将性工作和经常伴随的药物使用定为刑事犯罪。当考虑到女性性工作者的艾滋病毒风险时，更好地理解和调整这些方法的必要性是显而易见的。为了填补这一空白，研究的目的是：1)探索巴尔的摩市警察领导层(N=15)和在巴尔的摩市高犯罪区工作的街头警察(N=30)中FSWs的警察文化、态度和经验；2)检查FSWs的艾滋病毒危险行为(例如，无保护措施的性行为、不安全的注射做法、吸毒)与警察在12个月期间遇到警察的频率和类型(即，言语和性骚扰、性剥削、避孕套和没收注射器)之间的联系；以及3)研究艾滋病病毒/性传播感染的发病率和流行率与一组性工作者(N=250)在12个月期间与警察相遇的频率和类型之间的关系。在实现目标1中，我们将进行组织人种学，这是一种多方法方法，将使我们能够用自己的话深入审查警察文化、警察政策以及领导和巡逻警察的态度和经验。通过AIM 2，我们将招募和跟踪一批FSWs(N=250)，通过有针对性的抽样，在以街道为基础的地点，将通过二级数据分析、街道关键线人访谈和人种地图确定。通过这些数据，我们将检查危险毒品和性行为(即无保护措施的性行为、注射毒品)与警方随着时间的推移而发生的联系。数据将在基线、3个月、6个月、9个月和12个月时收集。这项提案在回应显示警察在暗娼艾滋病毒/性传播感染危险行为和感染中的中心地位的新兴全球证据库方面具有创新性。1、2、9、19、20这项研究融合了组织人种学、前瞻性定量研究和生物学结果，是美国首次努力更好地了解警察如何以及为什么在暗娼中发挥结构性艾滋病毒/性传播感染驱动因素的作用，进而为未来的干预奠定基础。这项研究将由一个由警察、法律、公共卫生、FSW和社区利益相关者组成的多部门社区咨询委员会(CAB)指导。警务专员的协调和支持将是制定这项工作所产生的可持续和现实干预措施的核心。？

 DESCRIPTION: Despite many shared goals, public health and public safety systems often do not collaborate and therefore may end up working at cross purposes. Their divergent responses to sex work are particularly striking, with public health focusing on health promotion and risk reduction in contrast to public safety's focus on criminalization of both sex work and the substance use that so often accompanies it. The need to better understand and align these approaches is evident when one considers female sex workers' (FSWs) HIV risk. To fill this gap, study aims are to: 1) to explore police culture, attitudes of, and experiences with FSWs among Baltimore city police leadership (N=15) and street-level police (N=30) working in high crime areas in Baltimore City; 2) to examine the association between the FSWs' HIV risk behaviors (e.g., unprotected sex, unsafe injection practices use, crack use) with police encounters the frequency and type (i.e., verbal and sexual harassment, sexual exploitation, condom and syringe confiscation) of police encounters, among a cohort of FSWs (N=250) over a 12-month period of time; and 3) to examine the association between HIV/STIs incidence and prevalence with the frequency and type of police encounters among a cohort of FSWs (N=250) over a 12-month period of time. In meeting Aim 1, we will conduct organizational ethnography, a multi-method approach, which will allow for an in-depth examination of police culture, police policies, as well as attitudes and experience of leadership and patrol police in their own words. Through Aim 2, we will enroll and follow a cohort of FSWs (N=250) through targeted sampling, at street-based venues that will be identified through secondary data analysis, street key informant interviews, and ethnographic mapping. Through these data, we will examine associations between risky drug and sexual behaviors (i.e., unprotected sex, injection drug use) with police encounters over time. Data will be collected at baseline, 3-, 6-, 9-, and 12-months. The proposal is innovative in responding to an emerging, global evidence base illustrating the centrality of police in FSWs' HIV/STI risk behaviors and infection.1,2,9,19,20 The study blends organizational ethnography, prospective quantitative research, and biological outcomes and represents the first US-based effort to better understand how and why police function as a structural HIV/STI driver among FSWs, and in turn lay the foundation for future interventions. The study will be guided by a multi-sectorial community advisory board (CAB) comprised of police, legal, public health, FSW, and community stakeholders. The CAB and support of the Police Commissioner will be central to the development of sustainable and realistic interventions stemming from this work. ¿