HIV Risk Environments among FSW and DU: A Longitudinal Ethno-Spatial Approach

描述（由申请人提供）：本申请的目的是应用一种新的民族空间方法来评估社会、结构和环境因素对非法药物使用者（DU）和女性性工作者（FSW）的HIV风险行为、HIV发病率和HIV治疗结局的影响。此外，我们还试图探索塑造这些人群风险轨迹的关键启动和过渡事件。我们提出的研究是嵌套在一个更大的研究计划，其中包括五个NIDA资助的纵向队列研究的成年DU和FSW和街头参与青年在温哥华，加拿大。因此，我们的方法提供了一个“增值”的机会，采用和整合多种数据收集和分析技术，以确定性工作和药物使用场景的社会，结构和物理特征对艾滋病毒结果的影响，并将包括人种学观察实地工作，深入访谈，地理空间映射技术，以及定量实验室和调查数据。通过这一努力，我们将寻求推进方法论的方法来研究艾滋病毒/艾滋病在弱势群体中，通过试行一种新的民族空间的方法来阐明复杂的途径，艾滋病毒的风险和艾滋病毒治疗之间的DU和FSW。此外，我们的目标是建立一个平台，正在进行的民族空间评估未来的干预措施，针对DU和FSW，可以复制在北美的其他设置。温哥华市是一个理想的设置为拟议的研究。像美国的许多城市一样，温哥华是毒品和性工作场所的所在地，在吸毒者和性工作者中艾滋病毒感染的负担很高。温哥华的官员和美国几个城市的官员一样，正在实施一系列政策和干预措施，旨在减少吸毒和性工作对公共卫生和公共秩序的影响，包括涉及警务、支持性住房和改造物理环境的政策和干预措施。新的证据表明，虽然这些干预措施可以减少公共秩序混乱，但它们往往对弱势群体产生意想不到的负面影响，促使人们呼吁将公共卫生和公共秩序举措结合起来。然而，这些干预措施对艾滋病毒风险行为、艾滋病毒发病率和艾滋病毒治疗结果的影响尚未完全阐明。同样，对DU和FSW之间形成风险轨迹的关键启动和过渡事件的相关影响也没有得到很好的理解。在全球范围内，人们日益认识到需要确定社会、结构和物质环境如何影响边缘化吸毒人群的健康，以及干预措施如何应对这些影响程度。评估社会和结构影响以及促进方法多样性已被确定为艾滋病研究办公室2011年国家卫生研究院跨计划的高度优先事项。因此，通过使用互补和创新的混合方法研究，我们的目标是解决几个紧迫的健康挑战，这将为加拿大和美国制定一系列政策和干预措施提供信息。

DESCRIPTION (provided by applicant): The purpose of this application is to apply a novel ethno-spatial approach to evaluate the impact of social, structural, and environmental factors on HIV risk behavior, HIV incidence, and HIV treatment outcomes among illicit drug users (DU) and female sex workers (FSW). As well, we seek to explore critical initiation and transition events that shape risk trajectories within these populations. Our proposed study is nested within a larger program of research that includes five NIDA-funded longitudinal cohort studies of adult DU and FSW and street-involved youth in Vancouver, Canada. Thus, our approach offers a 'value-added' opportunity to employ and integrate multiple data collection and analytic techniques to identify the impacts of social, structural and physical features of sex work and drug use scenes on HIV outcomes, and will include ethnographic observational fieldwork, in- depth interviews, geo-spatial mapping techniques, and quantitative laboratory and survey data. Through this effort we will seek to advance methodological approaches to the study of HIV/AIDS among vulnerable populations, by piloting a novel ethno-spatial approach to elucidate the complex pathways to HIV risk and HIV treatment among DU and FSW. Further, we aim to create a platform for the ongoing ethno-spatial evaluation of future interventions targeting DU and FSW that can be replicated in other settings within North America. The city of Vancouver is an ideal setting for the proposed research. Like many cities in the US, Vancouver is home to established drug and sex work scenes, and has experienced a high burden of HIV infection among DU and FSW. Officials in Vancouver, like those in several US municipalities, are implementing a range of policies and interventions aimed at reducing the public health and public order impacts of drug use and sex work, including those involving policing, supportive housing, and modifications to the physical environment. A nascent body of evidence suggests that while these interventions can reduce public disorder, they often have unintended negative consequences for vulnerable populations, prompting calls for an integration of public health and public order initiatives. However, the impact of such interventions on HIV risk behavior, HIV incidence, and HIV treatment outcomes has not been fully elucidated. Likewise, the associated impacts on critical initiation and transitional events among DU and FSW that shape risk trajectories are not well understood. Globally, there is growing recognition of the need to identif how social, structural and physical environments affect the health of marginalized drug using populations, and how interventions can address these levels of influence. The evaluation of social and structural influences and the promotion of methodological diversity have been identified as high priorities within the Office of AIDS Research's Trans-NIH Plan for 2011. Accordingly, through the use of complementary and innovative mixed-methods research, we aim to address several urgent health challenges, which will inform the development of a range of policies and interventions in both Canada and the United States.