Concurrent Partnerships Among High-Risk Couples in the U.S.-Mexico Border Region

描述（由申请人提供）：论文研究项目（R36）的总体目标是在美墨边境地区高风险吸毒女性性工作者（FSWs）及其非商业亲密男性伴侣中，对性伴侣并发（即重叠性伴侣）进行横剖面混合方法研究，这是HIV和其他性传播感染（sti）流行病学的一个重要因素。药物滥用、性工作和人口流动是该区域的特点，艾滋病毒/性传播感染在高风险人群（包括女职工和注射吸毒者）中出现了动态流行。尽管迄今为止，这些艾滋病毒/性传播疾病仍然集中，但在女性伴侣和亲密伴侣之间同时发生，可能会迅速促进艾滋病毒/性传播疾病向一般人群的“衔接”。尽管有大量关于并发性的文献，但在西半球资源贫乏的环境中，被边缘化的吸毒二人之间并发性的动机和背景知之甚少。本论文旨在描述高风险双性恋者并发性行为的社会背景（目标1），并确定美墨边境地区高风险FSWs（目标2）及其亲密男性伴侣（目标3）中并发性行为的性别特征及其相关因素。为了实现这些目标，我们将在Proyecto Parejas （R01-DA02772; PI: S. Strathdee）中采用定性和定量方法实施横断面混合方法设计，这是一个现有的来自蒂华纳和华雷斯Cd的200对高风险吸毒的fsw及其亲密男性伴侣的队列（N=400名受试者）。为了实现目标1，我们将有针对性地抽样约20名女性和约20名男性（N=40），他们在现有的基线定量调查中报告了最近（去年）的并发性行为，这些调查使用联合国艾滋病规划署推荐的性伴侣历史模块来测量并发性。我们将对该子样本进行半结构化访谈，这将不同于父母研究的数据收集，以定性地探索并发性的含义和动机，包括可能促进或阻碍并发性行为的社会和环境因素。然后，我们将使用涌现的定性发现来开发一个概念框架和具体假设来指导定量分析。为了满足目标2和目标3，我们将使用来自整个队列200对（N=400）的现有定量基线数据。我们将确定并发患病率，并应用多层次（即二元）逻辑回归来确定fsw（目标2）及其亲密男性伴侣（目标3）的并发性在个体和关系层面的相关性。我们的二元混合方法研究设计将首次对一个以普遍吸毒、性交易和人口流动为特征的地区的并发性进行深入调查。它还将使PI成为药物滥用研究领域具有竞争力的新研究者。研究结果对于制定以证据为基础的、针对性别的干预措施，以降低吸毒的女伴及其亲密男性伴侣的艾滋病毒/性传播感染风险至关重要。

DESCRIPTION (provided by applicant): The overall goal of the proposed dissertation research project (R36) is to conduct a cross-sectional mixed methods study of sexual partner concurrency (i.e., overlapping sexual partnerships), an important factor in the epidemiology of HIV and other sexually transmitted infections (STIs), among dyads of high-risk, drug using female sex workers (FSWs) and their non-commercial, intimate male partners in the U.S.-Mexico border region. Substance abuse, sex work, and population mobility are features of the region, where a dynamic epidemic of HIV/STIs has emerged in high-risk populations including FSWs and injection drug users (IDUs). Although to date these HIV/STI epidemics remain concentrated, concurrency among FSW-intimate partner dyads could rapidly promote the "bridging" of HIV/STIs to the general population. Despite the vast literature on concurrency, little is known about the motivations for and contexts surrounding concurrency among marginalized, drug-using dyads in resource-poor settings in the Western Hemisphere. The proposed dissertation study seeks to characterize the social context of concurrency for high-risk dyads (Aim 1) and determine the gender-specific prevalence and correlates of concurrency among high-risk FSWs (Aim 2) and their intimate male partners (Aim 3) in the U.S.-Mexico border region. To meet these aims, we will implement a cross-sectional mixed methods design using qualitative and quantitative methods within Proyecto Parejas (R01-DA02772; PI: S. Strathdee), an existing cohort of 200 dyads of high-risk, drug-using FSWs and their intimate male partners in Tijuana and Cd. Juarez (N=400 subjects total). To meet Aim 1, we will purposively sample ~20 women and ~20 men (N=40) reporting recent (past year) concurrency in existing baseline quantitative surveys that measured concurrency using a UNAIDS-recommended sexual partner history module. We will conduct semi-structured interviews with this subsample, which will be distinct from data collection of the parent study, to qualitatively explore the meanings of and motivations for concurrency including social and environmental factors that may promote or discourage concurrency behaviors. We will then use emergent qualitative findings to develop a conceptual framework and specific hypotheses to guide quantitative analyses. To meet Aims 2 and 3, we will use existing quantitative baseline data from the entire cohort of 200 dyads (N=400). We will determine concurrency prevalence and apply multilevel (i.e., dyadic) logistic regression to identify individual- and relationship-level correlates of concurrency for FSWs (Aim 2) and their intimate male partners (Aim 3). Our dyadic, mixed methods study design will provide the first in-depth investigation of concurrency in a region characterized by prevalent drug use, commercial sex, and population mobility. It will also position the PI as a competitive new investigator in drug abuse research. Findings will be critical to the development of evidence-based, gender-specific interventions to reduce HIV/STI risk among drug-using FSWs and their intimate male partners.