Migration, Tourism and the HIV-drug use Syndemic in the Dominican Republic

描述（由申请人提供）：加勒比地区是世界上艾滋病毒流行率第二高的地区，仅次于撒哈拉以南非洲，也是该地区受非法药物使用和药物贩运影响最严重的地区之一。针对多米尼加共和国男子不断变化的工作、移徙、性行为和吸毒行为，拟议的混合方法协作研究探讨了移徙男子中艾滋病毒风险和吸毒与（1）移徙模式和（2）旅游区社会环境的关系。我们通过旅游生态的概念将当代人口变化与艾滋病毒和药物使用实践联系起来-地理限制区域，其中五个生态特征（社会隔离;社会耻辱;商业规范;旅游逃避现实;以及药物和酒精的可用性）被假设为有助于高风险行为。我们的研究基本上依赖于一个长期的多部门社区咨询委员会，包括私人旅游代表，政府，公共卫生官员和民间社会。数据收集包括：（1）对两个沿海旅游区系统选择的36名男性农民工进行半结构式访谈（2）利用Arc-GIS对两个旅游区进行民族志制图和空间分析;（3）对两个研究点的400名男性农民工进行横断面调查;以及（4）对40名男性外来旅游工人实施试点干预。这项研究有助于公众健康知识和健康促进在三个关键方面。首先，它确定了旅游区的因素， 艾滋病毒风险和药物使用，有助于制定和试行循证干预措施。其次，它利用了大量的文献，系统地分析了旅游环境对艾滋病毒和毒品使用的高风险环境中的健康影响。最后，它纳入了一个参与性的研究过程，这将加强当地的相关性，研究翻译， 对卫生政策和方案的影响。

DESCRIPTION (provided by applicant): The Caribbean region has the second highest prevalence rates of HIV in the world following sub-Saharan Africa and is one of the region's most affected by illicit drug use and drug trafficking. Focusing on men's changing work, migration, and sexual and drug use behavior in the Dominican Republic, the proposed mixed- methods collaborative study examines how HIV risk and drug use among migrant men are related to (1) patterns of migration and (2) the social environments of tourism areas. We relate contemporary demographic changes to HIV and drug use practices through the notion of tourism ecologies - geographically constrained areas in which five ecological features (social isolation; social stigma; business norms; touristic escapism; and drug and alcohol availability) are hypothesized to contribute to high risk behaviors. Our research relies fundamentally on a long-standing multisectoral Community Advisory Board involving private tourism representatives, government, public health officials, and civil society. Data collection consists o: (1) semi- structured interviews with 36 systematically selected male migrant workers in two coastal tourism areas (two interviews per subject = 72 sessions); (2) ethnographic mapping and spatial analysis using Arc-GIS in two tourism areas; (3) a cross-sectional survey with 400 male migrant workers in two research sites; and (4) the implementation of a pilot intervention with 40 migrant male tourism workers. This study contributes to public health knowledge and health promotion in three key ways. First, it identifies the factors in tourism areas that most contribute to HIV risk and drug use, contributing to the development and piloting of an evidence-based intervention. Second, it draws on an extensive literature to systematically analyze the health effects of tourism environments in high-risk settings for HIV and drug use. Finally, it incorporate a participatory process to research that will strengthen local relevance, research translation, and the impact on health policies and programs.