Identifying Opportunities for HIV Prevention Among Female Migrants in Kenya

描述（由申请人提供）：这个受指导的研究项目将调查非洲艾滋病研究不足的一个方面：女性移民的艾滋病预防需求。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，在整个地区，妇女参与移民的水平已经达到或超过了男子。此外，调查女性移徙者艾滋病毒风险的少数研究发现，与非移徙妇女相比，移徙妇女的风险行为和艾滋病毒流行率更高。我的论文研究发现，在南非，移民与女性感染艾滋病毒的风险比男性高有关。这一发现在东非得到了证实，在那里，艾滋病正在给社区造成毁灭性的打击，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。先前的研究发现，肯尼亚男性和女性都高度参与移民，移民的性风险行为高于非移民。然而，人们对参与移徙导致妇女高风险行为的机制知之甚少。我提出的计划将弥补这一差距。它由两个阶段组成：二级数据分析和在肯尼亚进行的深入定性研究。这两个“模块”将涉及以下目标：(1)评估肯尼亚妇女参与移徙对其感染艾滋病毒的影响程度，并确定妇女移徙可能增加其感染艾滋病毒风险的解释机制。我将使用来自肯尼亚人口、健康和艾滋病指标调查和人口监测实地站点的二手数据进行分析，以实现这一目标。利用“艾滋病毒三角测量”，我将在与肯尼亚当地利益相关者的参与性研讨会上评估这些发现以及来自其他来源的信息。这项工作将为将在目标2中进行的定性研究的设计提供信息：(2)描述肯尼亚尼扬扎省妇女移徙经历的社会和心理方面，这些方面增加了她们感染和传播艾滋病毒的风险。我将采用参与性观察和深度访谈的方法来描述女性移徙共同目的地的空间和社会特征，并确定影响她们感染艾滋病毒风险的妇女移徙的结构和心理方面。这些女性移民感染艾滋病毒的前因可作为艾滋病毒预防干预的潜在点，从而为目标3奠定基础：(3)制定针对Nyanza女性移民的多层次艾滋病毒预防干预的初步计划。在与当地利益相关者的参与性研讨会上，我将批判性地评估本研究的累积成果，确定对女性移民的潜在干预点，评估各种选择的可接受性，并制定初步干预计划。在第四年开始时，我将向NIMH提交一份R34申请，以进行形成性研究，以开发和评估干预措施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.