HIV & STD Risks in Tele Aviv

以色列的艾滋病毒流行率和发病率很低，其特点是有两种传播模式，一种是以色列本地男子之间的同性恋和IDU传播，另一种是1990年代移民的埃塞俄比亚犹太人之间的异性恋传播。在过去三年中，细菌性性传播疾病的发病率大幅上升。这些增长，再加上大型交易性工作产业的发展，以及目前的中东冲突，有可能改变这种模式。目前在以色列估计有3000名这样的交易工人，其中大多数位于特拉维夫大都市区，其中估计80%是非法移民，主要来自前苏联地区。客户既有以色列本地人，也有外国工人。一项针对300名工人的性传播疾病/艾滋病毒流行情况的初步研究发现，性传播疾病的发病率很高，但只有0.3%的人是艾滋病毒阳性，卫生部正在特拉维夫市中心开设一家专门的诊所。艾滋病毒很容易传入并传播到特拉维夫人口中，但鉴于目前艾滋病毒血清阳性率较低，积极的干预措施可能非常有效。在这个ir03项目中，我们建议在特拉维夫的这一人群中进行试点形成和调查研究。我们将对从街头、诊所和其他场所招募的关键线人和工作人员进行60次深入的人种学访谈。这将为开发一种调查工具提供信息，该工具将用于采访来自每个地点的240名工作人员。我们的具体目标是：1)评估工人的HIV/STD知识、意识和行为；2）. 3)研究这些人（其中许多是非法居民）的法律地位如何影响他们获得医疗保健和信息、公民权利、安全和工作条件；4)研究社会动荡和以色列-巴勒斯坦冲突如何影响艾滋病毒和性传播疾病的传播（例如，通过移民模式的变化、健康教育或服务的中断）；5)探索建立纵向研究队列的可行性。访谈将以俄语或希伯来语进行，使用标准的定性技术进行转录和分析。该项目的数据将用于评估新诊所的疗效，并制定以艾滋病毒预防为重点的行为和/或结构干预措施。

HIV prevalence and incidence in Israel is low and has been characterized by two transmission patterns, by homosexual and IDU transmission among native Israeli men, and by a heterosexually transmitted epidemic among Ethiopian Jews who immigrated in the 1990s. In the past 3 years, bacterial STD rates have increased substantially. These increases, coupled with development of a large transactional sex work industry, and the current Middle East conflict, and the current Middle East conflict have the potential to alter this pattern. There are currently an estimated 3,000 such transactional workers in Israel, with the majority located in the Tel Aviv metropolitan area, of whom an estimated 80% are illegal immigrants, predominantly area from the former Soviet Union. Clients are a mix of native Israelis and foreign workers. An initial STD/HIV prevalence study in 300 workers found high rates of STDs, but only 0.3% were HIV positive, and the Ministry of Health is opening a dedicated clinical in downtown Tel Aviv. HIV could be easily introduced and disseminated into the Tel Aviv population, but with the current low HIV seroprevalence aggressive interventions could be highly effective. In this I R03 project, we propose pilot formative and survey research in this population in Tel Aviv. We will perform 60 in depth ethnographic interviews in key informants and workers recruited from street outreach, from the clinic and from other venues. This will inform the development of a survey instrument, which will be used to interview 240 workers from each venue. Our specific aims are: 1) To assess HIV/STD knowledge, awareness, and behaviors of workers; 2). To characterize the client mix 3) To examine how the legal status of these individuals, many of whom are illegal residents, impacts their access t health care and information, civil rights, safety, and working conditions; 4) To examine how social unrest and the Israel-Palestinian conflict impacts the transmission of HIV and STDs (e.g., through changes in migration patterns, disruptions in the provision of health education or services; 5) explore the feasibility of developing a cohort for longitudinal study. Interviews will be conducted in Russian or Hebrew, transcribed and analyzed using standard qualitative techniques. Data from this project will be used to evaluate efficacy of a new clinic, and to develop behavioral and/or structural interventions focused on HIV prevention.