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(STI)的关键人群。1-6性工作的定义是收受金钱或货物以换取性服务。7有确凿的证据表明，一些异国舞者明确地出卖性，因此可能是非正式女性性工作者的一个重要亚群。8-11此外，异国舞蹈可能是开始或升级非法药物使用的门户。8、12、13我们假设有许多 女性开始在异国舞蹈俱乐部(EDC)跳舞，根据EDC的环境，随着时间的推移，可能会开始或升级非法药物使用和性交易。有越来越多的文献关注环境因素在塑造个人层面艾滋病毒行为中的作用。14-17罗兹开发了艾滋病毒“风险环境”框架，强调背景的至高无上，并将风险原因从个人转移到行为发生的社会环境和结构。15，16研究表明，性工作者中的艾滋病毒/性传播感染风险受到环境特征的影响(例如性工作的合法性，18-20找出幼儿发展中心环境中促进或抑制风险的方面，可为在该人群和其他弱势人群中预防艾滋病毒/性传播感染提供新的选择。这一调查的关键第一步是制定量化的风险环境措施，并收集初步证据表明，由于暴露在危险的EDC环境中，性工作和药物使用随着时间的推移而增加。我们的研究旨在开发风险环境领域的定量测量，以及招募、登记和跟踪巴尔的摩新(&lt；6个月)异国舞者(N=90)的队列。具体地说，我们的目标是：1)开发和验证一个测量工具，从四个领域(即物理、社会、经济和政策)来表征异国舞蹈俱乐部的风险环境；2)招募、招募和留住新的女性异国舞者(N=90)，随着时间的推移，在低(n=3)和高风险(n=3)的EDC环境中招募、招募和留住新的女性异国舞者，以测试未来更大规模纵向研究的可行性。新的异国舞者将被定义为在学习入学前6个月开始跳舞的女性异国舞者；3)定量和定性地探索异国舞者进入EDC和继续工作的性质，包括在六个月的时间里检查这种环境中性和毒品危险行为的启动和/或升级。目前的探索性、可行性研究有可能为在风险环境中进行量化提供新的方法，将为如何最好地招募和跟踪研究人群提供洞察，并将为未来对这一未被研究但可能具有重要意义的人群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.