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

描述（由申请人提供）：本指导研究科学家发展奖（K01）的目的是三重的。这个奖项将使我能够：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；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/墨西哥边境），拓宽我对吸毒者中HIV的社会流行病学的理解；3)帮助我过渡到加州大学圣地亚哥分校，成为一名由美国国立卫生研究院资助的富有成效的独立研究员。培训目标将通过具体讲习班和课程、实践研究项目以及由弱势群体艾滋病毒预防研究、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综合、摄影人种学、伦理学、以及国际背景下的艾滋病社会流行病学研究（特别是美国/墨西哥边境地区）。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）进行一项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的混合方法研究来实现。该研究项目将作为现有NIH/ nida资助的R01， DA028692-01（“墨西哥/美国边境fsw的HIV/STI风险环境演变”，又名proyeto Mapa Salud， PI Kimberly Brouwer）的独立附属项目进行，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，集中在吸毒者和外籍女工等高风险群体中。地理空间和定性方法多年来一直用于探索与艾滋病毒在高危人群中传播有关的因素，然而，将两者结合起来的新兴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吸毒有关的风险方面的作用，以及了解导致高风险个人在特定类型地点消费毒品的社会因素，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干预措施至关重要。拟议的研究将使我能够运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，探索在注射环境中，FSW注射者认为哪些因素是“可取的”和“不可取的”，以及从公共卫生的角度来看，他们生活中的哪些社会因素导致他们在“更安全”或“不太安全”的环境中注射。这项工作将在特别高风险的人群中进行（在蒂华纳，男性注射吸毒者的艾滋病毒感染率为4%，女性为10%，同时从事性工作的女性为12%）。拟议研究的结果对于为边境地区因吸毒而有感染艾滋病毒风险的个人制定量身定制的干预措施，以及发展关于“空间”在艾滋病毒风险中的作用的未来研究至关重要。此外，开发地理空间、视觉和地理空间/定性混合方法方面的技能，将使我成为在药物滥用领域拥有这种技能的少数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系唯一的研究人员。

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.