Venue-level Risks for HIV/STI among Male Clients of FSWs in Tijuana, Mexico

简介(申请人提供)：本次导师研究科学家发展奖(K01)的目的有三个。这一奖项将使我：1)学习三种新的技能：定量和混合方法；多水平建模；以及定性数据和高级定量建模数据的集成；2)在新的文化和环境背景(美国和墨西哥边境)中拓宽我对药物使用者和艾滋病毒使用的理解；3)促进我过渡到加州大学圣地亚哥大学NIH资助的一名富有成效的独立研究员。培训目标将通过具体的讲习班和课程作业、实践研究项目以及与培训委员会的一对一指导相结合来实现，培训委员会由以下领域的专家组成：在使用脆弱物质的人群中进行艾滋病毒预防研究、定性和混合方法研究、多层次建模、伦理学和国际背景下(特别是美国/墨西哥边境地区)的药物使用流行病学研究。研究目的将通过对墨西哥蒂华纳FSW男性客户中影响艾滋病毒风险的性工作环境的社会和结构方面进行混合方法研究来实现。这项研究将作为NIH/NIDA资助的现有R01 DA029008(“为墨西哥提华纳女性性工作者的男性客户提供更安全的性行为干预”，又名Hombre Seguro，PI：Thomas Patterson)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艾滋病毒的迅速流行，集中在FSW、男性客户和吸毒者等高危群体中。虽然研究人员长期以来一直将混合方法应用于艾滋病毒/性传播感染的预防，但很少有研究人员将从定性方法收集的丰富信息与多水平或分层线性建模等高级统计方法相结合。此外，研究人员尚未使用混合方法来提供细微差别的背景理解，以了解哪些亚组可以受益于降低风险干预，以及为什么和如何受益。拟议的研究将使我能够在定性和混合方法中应用新获得的技能，并整合定性和多级建模数据，以探索性工作场所与性工作者发生性行为时使用药物的风险环境因素。这项工作将在特别高危人群中进行(在提华纳，女性性工作者的艾滋病毒感染率为6%，男性客户为5%)。拟议研究的结果将对为边境地区和其他国际环境中的艾滋病毒高危人群制定多层次干预措施，以及发展未来将先进的定量技术与艾滋病毒预防中的定性方法相结合的混合方法研究至关重要。此外，发展定性和混合方法的技能，以及多层次建模，将使我成为物质使用和性工作领域为数不多的拥有此类技能的混合方法研究人员之一，也是全球公共卫生部门和加州大学圣地亚哥分校唯一的研究人员。

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: quantitative and mixed methodologies; multilevel modeling; and the integration of qualitative data and advanced quantitative modeling data; 2) broaden my understanding of substance use and HIV among substance 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 substance using populations, qualitative and mixed methods research, multilevel modeling, ethics, and drug use 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 social and structural aspects of sex work environments influencing HIV risk among male clients of FSW in Tijuana, Mexico. The research will be conducted as an independent adjunct to an existing NIH/NIDA-funded R01, DA029008 ("Safer Sex Intervention for Male Clients of Female Sex Workers in Tijuana, Mexico" aka Hombre Seguro, PI: Thomas Patterson), 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 FSW, male clients, and drug users. While researchers have long applied mixed methods to HIV/STI prevention, few researchers have integrated rich information gleaned from qualitative methods with advanced statistical methods like multilevel, or hierarchical linear modeling. Further, researchers have yet to utilize mixed methods to provide a nuanced, contextual understanding of which sub-groups do and do not benefit from risk reduction interventions, as well as why and how. The proposed research will allow me to apply newly acquired skills in qualitative and mixed methods and integrating qualitative and multilevel modeling data to explore risk environments factors surrounding substance use in the context of sex with FSW in sex work venues. This work will be conducted in a particularly high-risk population (in Tijuana, HIV prevalence among female sex workers is 6% and 5% for male clients). Findings from the proposed research will be critical for developing multi-level interventions for substance using populations at risk for HIV in border regions and other international settings, and for the development of future mixed methods research integrating advanced quantitative techniques with qualitative approaches in HIV prevention. Further, developing skills in qualitative and mixed methods, and multilevel modeling will uniquely position me as one of only a handful of mixed-methods researchers in the field of substance use and sex work possessing such skills, and the only one in the Division of Global Public Health and the University of California San Diego.