A Mixed-Method Study of Injection Drug Use Settings Among FSWs in Tijuana

简介(申请人提供)：本次导师研究科学家发展奖(K01)的目的有三个。这一奖项将使我：1)学习三种新技能：地理空间分析；将地理空间技术与定性方法相结合；以及使用视觉/摄影方法作为定性研究的辅助手段；2)在新的文化和环境背景下(美国和墨西哥边境)扩大我对吸毒者艾滋病毒社会流行病学的理解；3)促进我过渡到加州大学圣地亚哥大学NIH资助的一名富有成效的独立研究员。培训目标将通过具体的讲习班和课程、实践研究项目以及与培训委员会的一对一指导相结合来实现，培训委员会由以下领域的专家组成：脆弱人群中的艾滋病毒预防研究、地理信息系统和地理空间分析、混合方法研究、地理空间和定性方法的整合、照片人种学、伦理学和国际(特别是美国/墨西哥边境地区)的艾滋病毒社会流行病学研究。研究目的将通过对墨西哥蒂华纳60名注射毒品的女性性工作者(FSWs)对注射环境的态度和在特定环境中使用毒品的社会结构背景进行的混合方法研究来实现。该研究项目将作为NIH/NIDA资助的现有R01 DA028692-01(“墨西哥/美国边境暗娼不断演变的艾滋病毒/性传播感染风险环境”，又名Proyecto Mapa Salud，Pi Kimberly Brouwer)的独立附属项目，以利用该项目所代表的基础设施和专业知识。美国/墨西哥边境正在经历一场迅速蔓延的艾滋病毒疫情，集中在吸毒者和暗娼等高危群体中。多年来，人们一直使用地理空间和定性方法来探索与艾滋病毒在高危人群中传播有关的因素，但将两者结合在一起的新方法尚未应用于艾滋病毒传播的研究。了解物理空间在增加或减少与注射毒品有关的风险方面的作用，以及了解导致本已处于高危状态的个人在特定类型的地点吸食毒品的社会因素，对于改进旨在减少传染病在边境地区传播的个人和社区一级的干预措施至关重要。这项拟议的研究将使我能够应用新获得的地理空间分析技能，并将地理空间技术与定性方法相结合，以探索FSW注射者从公共健康角度出发，认为注射环境中的哪些因素是“可取的”和“不可取的”，以及他们生活中的哪些社会因素导致他们在“更安全”或“LES安全”的环境中进行注射。这项工作将在特别高危人群中进行(在提华纳，注射吸毒者的艾滋病毒感染率为男性4%，女性10%，也参与性工作的女性12%)。这项拟议研究的结果将对为边境地区通过吸毒感染艾滋病毒的高危个人制定量身定做的干预措施至关重要，也对于未来发展“空间”在艾滋病毒风险中的作用的研究至关重要。此外，发展地理空间、视觉和混合地理空间/定性方法的技能将使我成为药物滥用领域为数不多的拥有此类技能的混合方法研究人员之一，也是加州大学圣地亚哥分校全球公共卫生部门唯一的研究人员。 公共卫生相关性：美国/墨西哥边境是吸毒者(包括女性性工作者)等弱势群体中不断发展的艾滋病毒流行的发源地，但很少有研究评估影响该地区艾滋病毒传播的社会空间因素的作用。拟议研究的结果将对两国发展的努力至关重要。 为有艾滋病毒风险的吸毒者和其他吸毒负面后果的吸毒者量身定做的干预措施，以及开展未来关于“空间和地点”对高危注射人群中艾滋病毒风险的影响的长期研究。此外，发展地理空间、视觉和混合地理空间/定性方法方面的技能将使候选人成为药物滥用领域为数不多的拥有此类技能的混合方法研究人员之一，也是加州大学圣地亚哥分校全球公共卫生司唯一的研究人员。

DESCRIPTION (provided by applicant): The purpose of this Mentored Research Scientist Development Award (K01) is threefold. This award will allow me to: 1) learn three new skill sets: geospatial analysis; integrating geospatial techniques with qualitative methodologies; and the use of visual/photographic methods as an adjunct to qualitative research; 2) broaden my understanding of the social epidemiology of HIV among drug users in a new cultural and environmental context (the US/Mexico border); and 3) facilitate my transition to becoming a productive NIH-funded independent investigator at the University of California San Diego. The training aims will be accomplished through a combination of specific workshops and coursework, a hands-on research project, and one-on-one mentoring with a Training Committee comprised of experts in the areas of HIV prevention research among vulnerable populations, GIS and geospatial analysis, mixed methods research, the integration of geospatial and qualitative methodologies, photo-ethnography, ethics, and HIV social epidemiology research in international contexts (and specifically the US/Mexico border region). The research aims will be accomplished by conducting a mixed-methods study of attitudes toward injecting environments and the sociostructural contexts of the use of drugs in particular environments among 60 female sex workers (FSWs) who inject drugs in Tijuana, Mexico. The research project will be conducted as an independent adjunct to an existing NIH/NIDA-funded R01, DA028692-01 ("Evolving HIV/STI risk environments of FSWs on the Mexico/US border" aka Proyecto Mapa Salud, PI Kimberly Brouwer), in order to capitalize on the infrastructure and expertise represented by that project. The US/Mexico border is experiencing a burgeoning HIV epidemic, concentrated among high-risk groups such as drug users and FSWs. Geospatial and qualitative methods have been used for many years to explore factors associated with the spread of HIV among high risk populations, however emergent methodologies which combine the two have yet to be applied to the study of HIV transmission. Understanding the role of physical space in increasing or decreasing risk associated with injecting drug use, and understanding the social factors which lead already high risk individuals to consume drugs in specific types of location, are critical to improving both individual and community level interventions designed to reduce the spread of infectious disease in border regions. The proposed research will allow me to apply newly acquired skills in geospatial analysis and integrating geospatial techniques with qualitative methods to explore which factors FSW injectors see as 'desirable' and 'undesirable' in an injecting environment, and what social factors in their lives lead them to inject in 'safer' or 'les safe' environments from a public health perspective. This work will be conducted in a particularly high-risk population (in Tijuana, HIV prevalence among those who inject drugs is 4% for men, 10% for women, and 12% for women who also participate in sex work). Findings from the proposed research will be critical for developing tailored interventions for individuals at risk fo HIV via drug use in border regions, and for the development of future research into the role of 'space' in HIV risk. Further, developing skills in geospatial, visual, and mixed geospatial/qualitative methods will uniquely position me as one of only a handful of mixed-methods researchers in the field of drug abuse possessing such skills, and the only one in the Division of Global Public Health at the University of California San Diego. PUBLIC HEALTH RELEVANCE: The US/Mexico border is home to an evolving HIV epidemic among vulnerable groups such as drug users, including female sex workers (FSWs), but little research has assessed the role of socio-spatial factors influencing the transmission of HIV in this region. Findings from the proposed research will be critical to bi-national efforts to develop tailored interventions for drug users at risk for HIV and other negative consequences of drug use, and for the development of future long-term research into the influence of 'space and place' on HIV risk among high risk injecting populations. Further, developing skills in geospatial, visual and mixed geospatial/qualitative methods will uniquely position the candidate as one of only a handful of mixed-methods researchers in the field of drug abuse possessing such skills, and the only one in the Division of Global Public Health at the University of California San Diego.