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

 产品说明：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，因此可能最终在相互矛盾的目的上发挥作用。他们对性工作的不同反应尤其引人注目，公共卫生侧重于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性工作的药物使用定罪。当考虑女性性工作者（FSW）的艾滋病毒风险时，更好地理解和协调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）探索警察文化，态度，和经验之间的巴尔的摩市警察领导（N=15）和街头警察（N=30）在高犯罪率地区工作的巴尔的摩市; 2）检查之间的关联FSW的艾滋病毒风险行为（例如，无保护的性行为，不安全的注射做法的使用，快克使用）与警察遭遇的频率和类型（即，言语和性骚扰，性剥削，避孕套和注射器没收）的警察遭遇，在一个队列的FSW（N=250）在12个月的时间;和3）检查艾滋病毒/性传播感染的发病率和患病率与频率和类型的警察遭遇一个队列的FSW（N=250）在12个月的时间。为了实现目标1，我们将进行组织民族志，这是一种多方法的方法，可以深入研究警察文化，警察政策，以及领导和巡逻警察的态度和经验。通过目标2，我们将通过有针对性的抽样，在街头场所招募并跟踪一组FSW（N=250），这些场所将通过二级数据分析、街头关键线人访谈和人种学制图确定。通过这些数据，我们将研究危险药物和性行为之间的联系（即，无保护的性行为，注射毒品）与警察的遭遇随着时间的推移。将在基线、3、6、9和12个月时收集数据。该提案在回应一个新兴的全球证据基础方面具有创新性，该证据基础说明了警察在FSW的艾滋病毒/性传播感染风险行为和感染中的中心地位。1，2，9，19，20该研究融合了组织人种学、前瞻性定量研究和生物学结果，代表了美国首次努力更好地理解警察如何以及为什么在FSW中发挥结构性艾滋病毒/性传播感染驱动力的作用，并为今后的干预奠定基础。这项研究将由一个多部门社区咨询委员会（CAB）指导，该委员会由警察、法律的、公共卫生、家庭社会福利和社区利益攸关方组成。咨询委员会和警务专员的支持将是根据这项工作制定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. ¿