Substance Use and HIV Risk among Thai Women

描述（由申请人提供）：泰国朱拉隆功大学的Usaneya Perngparn女士和加州公共卫生研究所的Nemoto博士拟议的合作研究将调查曼谷泰国女性和男变女变性性工作者中艾滋病毒风险行为和药物使用的社会文化背景。1989年实施的100%使用避孕套的全国运动在减少新的艾滋病毒/性传播感染方面取得了成功。然而，最近的研究表明，在性活跃的年轻男性和女性中，安全套的持续使用水平很低，而在高危人群中，如直接的女性性工作者、吸毒者、男男性行为者以及男性和性工作者中，艾滋病毒的血清患病率很高。在泰国，由于佛教的业力观念，它们在历史上一直被接受。目前，许多女性从事性工作。最近的一项研究报告称，艾滋病毒血清患病率在同性恋人群中很高，特别是那些从事性工作的人（17%）。尽管泰国女性和男性性工作者的HIV/STI血清患病率和HIV风险行为较高，但很少有研究调查与她们的HIV风险行为相关的社会文化因素，例如她们的工作场所和环境、宿命论、生存和向家庭寄钱的经济压力，以及避免HIV/STI感染和客户暴力的应对机制。为了遏制未来的艾滋病毒/性传播感染，需要研究开发包括女性和男性性工作者特有的社会文化因素的理论艾滋病毒预防模型。拟议的研究将对从曼谷的目标工作场所（酒吧/俱乐部、按摩院和街道）招募的女性和性工作者（36名女性和24名男性）进行总共60次定性访谈。研究的具体目的是：1)了解女性和男性性工作者具体工作环境下的物质使用和HIV危险行为，描述和探讨影响女性和男性性工作者物质使用和HIV危险行为的社会文化因素；2)描述女性和男性性工作者开始物质使用和物质成瘾的社会文化因素与背景变量的关系。3)描述与性别确认、女性化手术和激素使用相关的药物使用和HIV风险行为；4)结合定性和定量研究结果和社区投入，探索未来女性和性工作者药物滥用和HIV/STI预防研究的理论模型；5)透过专业会议、刊物及社区谘询委员会成员的网络，传播研究结果。公共卫生相关性：拟议的研究将调查影响泰国曼谷酒吧/俱乐部、按摩院和街头工作的女性和变性女性（kathoey）性工作者的物质使用和艾滋病毒风险行为的社会、文化和环境因素。最近的研究表明，这些性工作者的艾滋病毒/性传播感染和非法吸毒率很高。拟议的研究结果将有助于制定药物滥用和艾滋病毒/性传播感染预防干预方案，这些方案将在文化上适合泰国女性和性工作者。在国际上，需要研究如何将在美国被证明有效的干预措施转化和调整到其他社区和国际环境中，并从其他条件和文化中学习，以告知我们对不同人群中艾滋病毒相关风险、发病率和死亡率的原因、后果和差异的理解。

DESCRIPTION (provided by applicant): The proposed collaboration study between Ms. Usaneya Perngparn, Chulalongkorn University, Thailand and Dr. Nemoto, Public Health Institute, California, will investigate the sociocultural contexts of HIV risk behaviors and drug use among Thai female and male-to-female transgender (kathoey) sex workers in Bangkok. The national campaign of 100% condom use implemented in 1989 has been successful in reducing new HIV/STIs. However, recent studies indicated low levels of consistent condom use among sexually active young men and women and high HIV sero-prevalence rates among high risk populations, such as direct female sex workers, drug users, MSM, and male and kathoey sex workers. In Thailand, kathoey have been historically accepted because of the karmic idea in Buddhism. Currently, many kathoey engage in sex work. A recent study reported high HIV sero-prevalence rates among kathoey, particularly those who had engaged in sex work (17%). Despite the high HIV/STI sero-prevalence rates and HIV risk behaviors among female and kathoey sex workers in Thailand, very few studies have investigated the sociocultural factors in relation to their HIV risk behaviors, such as their work venues and environment, fatalism, economic pressure to survive and send money to their families, and coping mechanisms to avoid HIV/STI infection and violence from customers. Research is needed to develop theoretical HIV prevention models which include the sociocultural factors specific to female and kathoey sex workers in order to curb future HIV/STIs. The proposed study will conduct a total of 60 qualitative interviews with female and kathoey sex workers (36 female and 24 kathoey) who will be recruited from the targeted work venues in Bangkok (bars/clubs, massage parlors, and street). The specific aims of the study are: 1) To understand substance use and HIV risk behaviors among female and kathoey sex workers specific to their work environment, and describe and explore sociocultural factors which would influence their substance use and HIV risk behaviors, 2) To describe the sociocultural factors of inception of substance use and addiction to substances among female and kathoey sex workers in relation to background variables, 3) To describe substance use and HIV risk behaviors in relation to gender confirmation and feminization surgeries and hormone use among kathoey sex workers, 4) To explore the theoretical models for future substance abuse and HIV/STI prevention studies among female and kathoey sex workers by integrating qualitative and quantitative findings and community input, and 5) To disseminate study findings through professional meetings and publications and the networks of the Community Advisory Board members. PUBLIC HEALTH RELEVANCE: The proposed study will investigate the social, cultural, and environmental factors which influence substance use and HIV risk behaviors among female and transgender female (kathoey) sex workers who work at bars/clubs and massage parlors, and on the street in Bangkok, Thailand. Recent studies show the high HIV/STI infection rates and illegal drug use among these sex workers. The results of the proposed study will help to develop substance abuse and HIV/STI prevention intervention programs which will be culturally appropriate to Thai female and kathoey sex workers. Internationally, studies are needed on how to translate and adapt interventions that have proven to be effective in the U.S. to other communities and international settings, and to learn from other conditions and cultures to inform our understanding of the causes, consequences, and differences in HIV-related risks, morbidity, and mortality in diverse populations.