A feasibility study of the HIV/STI risk environment of vulnerable women

描述（申请人提供）：从事性工作的妇女被认为是传播和获得艾滋病毒和其他性传播感染的主要人群。1 -6性工作被定义为接受金钱或商品以换取性服务。7有确凿的证据表明，一些脱衣舞女明确出售性服务，因此可能是非正式女性性工作者的一个重要亚群。11此外，异国情调的舞蹈可能是非法药物使用的开始或升级的途径。 妇女开始在异国情调的舞蹈俱乐部（EDC）跳舞，根据EDC的环境，随着时间的推移，可能会开始或增加非法药物的使用和卖淫。 有越来越多的文献关注环境因素在形成个人层面的艾滋病毒行为中的作用。14 -17罗兹制定了一个艾滋病毒“风险环境”框架，强调环境的首要地位，并将风险的原因从个人转移到行为发生的社会环境和结构。16.研究表明，性工作者感染艾滋病毒/性传播感染的风险受到环境特点的影响（即，18 -20确定EDC环境中促进或抑制风险的方面可以为预防这一人群和其他弱势人群中的艾滋病毒/性传播感染提供新的选择。在这一调查中，关键的第一步是制定定量的风险环境措施，并收集初步证据，证明性工作和毒品使用随着时间的推移而增加，由于暴露于危险的EDC环境。 我们的研究旨在开发一个定量测量的风险环境域，以及招募，登记，并遵循一个队列的新的（<6个月）异国情调的舞者（N=90）在巴尔的摩。具体而言，我们的目标是：1）开发和验证一个测量工具，以沿着四个领域（即，身体、社会、经济和政策）; 2）随着时间的推移，在低风险（n=3）和高风险（n =3）EDC环境中招募、招募和保留新的女性异国舞者（N=90），以测试未来更大的纵向研究的可行性。新的异国情调舞者将被定义为在研究入组前<6个月开始跳舞的女性异国情调舞者;以及3）定量和定性地探索异国情调舞者进入和继续在EDC工作的性质，包括检查六个月内在这种环境中性和药物风险行为的开始和/或升级。目前的探索性可行性研究有可能为风险环境中的定量提供新方法，将为如何最好地招募和随访研究人群提供见解，并将为未来的观察和干预研究提供基础。

DESCRIPTION (provided by applicant): Women who engage in sex work are considered a key population in the transmission and acquisition of HIV and other sexually transmitted infections (STIs).1-6 Sex work is defined as the receipt of money or goods in exchange for sexual services.7 There is solid evidence that some exotic dancers explicitly sell sex and thus may be an important subpopulation of informal female sex workers.8-11 Furthermore, exotic dancing may be a gateway to the initiation or escalation of illicit drug use.8, 12, 13 We hypothesize that many women start dancing in exotic dance clubs (EDC) and, depending on the EDC environment, may begin or escalate illicit drug use and sell sex over time. There is a growing body of literature that focuses on the role of environmental factors in shaping individual-level HIV behaviors.14-17 Rhodes has developed an HIV "risk environment" framework that emphasizes the primacy of context and shifts the cause of risk from individuals to the social situations and structures in which behaviors occur.15, 16 Research has demonstrated that HIV/STI risks among sex workers are influenced by characteristics of the environments (i.e., legality of sex work, higher pay for unprotected sex) in which they sell sex.18-20 Identifying aspects of the EDC environment that promote or inhibit risk could provide new options for preventing HIV/STIs in this and other vulnerable populations. A crucial first step in this line of investigation is to devlop quantitative risk environment measures and to gather preliminary evidence that sex work and drug use increase over time due to exposure to risky EDC environments. Our study aims to develop a quantitative measurement of risk environment domains, as well as recruit, enroll, and follow a cohort of new (<6 months) exotic dancers (N=90) in Baltimore. Specifically, we aim to: 1) to develop and validate a measurement tool to characterize the risk environment of exotic dance clubs along four domains (i.e., physical, social, economic, and policy); 2) to enroll, recrui, and retain new, female exotic dancers (N=90) in low- (n=3) and high-risk (n=3) EDC environments over time in order to test feasibility for a future, larger longitudinal study. New exotic dancers will be defined as female exotic dancers who initiated dancing <6 months prior to study enrollment; and to 3) quantitatively and qualitatively explore the nature of entry and continued work in EDCs among exotic dancers, including examining the initiation and/or escalation of sexual and drug risk behaviors in this environment over a six month period. The current exploratory, feasibility study has the potential to contribute novel methods for quantifyin the risk environment, will provide insight into how to best recruit and follow-up the study population, and will provide a foundation for future observational and intervention research for this understudied yet potentially significant population.