Identifying Opportunities for HIV Prevention Among Female Migrants in Kenya

描述（由申请人提供）：这个指导研究项目将调查非洲艾滋病毒的一个研究不足的方面：女性移民的艾滋病毒预防需求。移徙和艾滋病毒研究几乎完全侧重于男性移徙者面临的艾滋病毒风险，往往未能衡量妇女因参与移徙而面临的风险。然而，在整个区域，妇女参与移徙的人数已达到或超过男子。此外，少数研究审查了女性移民的艾滋病毒风险，发现与非移民妇女相比，移民的风险行为和艾滋病毒流行率较高。我的论文研究发现，在南非，妇女感染艾滋病毒的风险高于男子。这一发现在东非得到了证实，那里的艾滋病毒/艾滋病正在摧毁社区，感染风险的性别差异令人震惊。肯尼亚尼扬扎省的艾滋病毒流行率是非洲最高的。以前的研究发现，肯尼亚的男女移民参与率很高，移民的性风险行为高于非移民。然而，人们对参与移民导致女性更高风险行为的机制知之甚少。我的计划将填补这一空白。它由两个阶段组成：二级数据分析和在肯尼亚的深入定性研究。这两个“单元”将涉及以下目标：（1）评估肯尼亚妇女感染艾滋病毒受其参与移徙影响的程度，并确定妇女移徙可能增加其艾滋病毒风险的解释机制。我将利用肯尼亚人口、健康和艾滋病指标调查和人口监测实地的次级数据进行分析，以实现这一目标。使用“艾滋病毒三角”，我将评估这些结果沿着从其他来源的信息在参与式研讨会与当地利益相关者在肯尼亚。这项工作将为目标2：（2）确定肯尼亚尼扬扎省妇女移徙经历的社会和心理特点提供信息，这些特点增加了她们感染和传播艾滋病毒的风险。我将使用参与观察和深入访谈来描述女性移民共同目的地的空间和社会特征，并确定影响其艾滋病毒感染风险的女性移民的结构和心理方面。这些女性移民感染艾滋病毒的前因是艾滋病毒预防干预的潜在点，从而为目标3：（3）制定一项针对尼扬扎女性移民的多层次艾滋病毒预防干预的初步计划奠定了基础。在与当地利益攸关方的参与性研讨会上，我将批判性地评估这项研究的累积结果，确定对女性移民进行干预的潜在点，评估各种选择的可接受性，并制定初步干预计划。在第4年开始时，我将向NIMH提交R34申请，进行形成性研究，以开发和评估干预的可行性和可接受性。

DESCRIPTION (provided by applicant): This mentored research project will investigate an under-researched aspect of HIV in Africa: the HIV prevention needs of female migrants. Migration and HIV research has almost exclusively focused on HIV risks to male migrants, often failing to measure the risks to women via their involvement in migration. Yet across the region, women's levels of participation in migration have met or exceeded those of men. Moreover, the few studies which have examined HIV risks to female migrants found higher risk behavior and HIV prevalence in migrant compared to non-migrant women. My dissertation study found that migration was associated with a higher risk of HIV infection in women than in men in South Africa. The finding warrants confirmation in East Africa, where HIV/AIDS is devastating communities and the sex disparity in infection risk is striking. HIV prevalence levels in Nyanza Province, Kenya are among the highest in Africa. Previous studies have found high levels of participation in migration by both men and women in Kenya and higher sexual risk behaviors among migrants than non-migrants. However, little is known about the mechanisms through which participation in migration leads to higher risk behavior in women. My proposed plan will address this gap. It is comprised of two phases: a secondary data analysis, and an in-depth qualitative study in Kenya. These two 'modules' will address the following aims: (1) Assess the degree to which HIV infection in women in Kenya is influenced by their participation in migration, and identify explanatory mechanisms by which women's migration may increase their HIV risks. I will use secondary data from Kenya Demographic and Health and AIDS Indicator Surveys and demographic surveillance field sites to carry out analyses to achieve this aim. Using 'HIV Triangulation', I will evaluate these findings along with information from other sources in participatory workshops with local stakeholders in Kenya. This exercise will inform the design of the qualitative study to be carried out in Aim 2: (2) Characterize social and psychological aspects of women's migration experience in Nyanza Province, Kenya which facilitate their risks of acquiring and transmitting HIV infection. I will use participant observation and in-depth interviews to characterize the spatial and social features of the common destinations of female migrants, and identify the structural and psychological aspects of women's migration that influence their HIV infection risks. These antecedents to HIV infection in female migrants serve as potential points of HIV prevention intervention, thus laying the groundwork for Aim 3: (3) Develop a preliminary plan for a multi-level HIV prevention intervention with female migrants in Nyanza. In participatory workshops with local stakeholders, I will critically evaluate the cumulative findings of this research, identify potential points of intervention with female migrants, assess acceptability of various options, and develop a preliminary intervention plan. At the start of year 4 I will submit an R34 application to the NIMH for a formative study to develop and assess the feasibility and acceptability of the intervention.