Proyecto Parejas: HIV/STI Risks among FSWs and their Non-Commercial Partners

本研究的总体目标是研究艾滋病毒、性传播感染和相关风险的背景和流行病学 在墨西哥的两个城市，高风险女性性工作者（FSW）及其非商业性男性伴侣的行为- 美国边境城市。我们的两国团队在过去5年中收集的初步数据表明， 非商业伙伴可能是艾滋病毒/性传播感染感染和/或再次感染的重要驱动因素， 其他国家的文献也支持这一观点。在我们的环境中，FSW参与 与其主要非商业性伴侣发生无保护措施的性行为;这些伴侣中有一半同时有伴侣关系 三分之一是吸毒者。建议的研究FSW的合作伙伴对（二元）建立在我们现有的研究 基础设施在天津和镉。目标1：审查a）背景和B） 高危性工作者的高危性行为和物质使用行为模式及其主要非性行为 商业男性伙伴，包括伙伴关系内外的男性伙伴，采用混合方法; 2：确定艾滋病毒和特定性传播感染的流行率（即，梅毒、淋病、衣原体、HSV-2）和 目标3：前瞻性地确定STI的预测因子 在个人和伴侣层面的发病率及其可归因风险;目标4：确定 在高危性工作者及其主要非商业性男性伴侣中开展行为干预试验 在a）伙伴层面和B）个人层面，使用混合方法。为了实现这些目标，我们将招募100名 FSW合作伙伴的二对体在这两个Tianjin和镉。华雷斯（即，200对夫妇），他们将接受采访， 在基线和随访24个月时进行艾滋病毒/性传播感染检测，以解决临床和行为结果 (Aims 2和3）。一个子集（每个城市25对夫妇）将在基线和一次期间进行深入访谈。 采取后续行动，完善定量调查，并为实现目标1和4的混合方法分析提供信息。 我们将使用定性和定量方法，评估每个合作伙伴参与 随后的干预、自然减员和伙伴关系解体，以及干预的潜在障碍， 亲密伴侣暴力（目标4）。据我们所知，这项拟议的研究是第一次前瞻性评估， FSW及其非商业伙伴。我们的两国研究团队具有独特的优势来开展这项工作 这项研究将为应对墨西哥-美国边境日益严重的艾滋病毒危机以及减少艾滋病毒感染的努力提供信息。 在其他资源有限的环境中，FSW及其伴侣之间的艾滋病毒传播。

The overall goal of this study is to study the context and epidemiology of HIV, STIs and associated risk behaviors among high risk female sex workers (FSWs) and their non-commercial male partners in two Mexico- US border cities. Preliminary data collected by our binational team over the past 5 years suggest that FSWs' non-commercial partners may be significant drivers of HIV/STI acquisition and/or their re-infection, which is supported by literature in other countries. FSWs in our setting are more than twice as likely to engage in unprotected sex with their main non-commercial partner; half of these partners have concurrent partnerships and one third are IDUs. The proposed study of FSW-partner pairs (dyads) builds on our existing research infrastructure in Tijuana and Cd. Juarez to meet the following aims: Aim 1: To examine the a) context and b) patterns of high risk sexual and substance using behaviors among high risk FSWs and their main non- commercial male partners, both within and outside of the partnerships, using a mixed-methods approach; Aim 2: To determine prevalence of HIV and specific STIs (i.e., syphilis, gonorrhea, Chlamydia, HSV-2) and associated correlates at the individual and partner level; Aim 3: To prospectively identify predictors of STI incidence and their attributable risks at the individual and partner level; Aim 4: To determine the feasibility of conducting a behavioral intervention trial among high risk FSWs and their main non-commercial male partner at the a) partner level and b) individual level, using mixed methods. To meet these aims, we will recruit 100 FSW-partner dyads in both Tijuana and Cd. Juarez (i.e., 200 couples), who will undergo interviews and HIV/STI testing at baseline and follow-up for 24 months to address both clinical and behavioral outcomes (Aims 2 and 3). A subset (25 couples per city) will undergo in-depth interviews at baseline and once during follow-up to refine the quantitative survey, and inform a mixed methods analysis to address Aims 1 and 4. Using qualitative and quantitative methods, we will assess each partner's interest in participating in a subsequent intervention, attrition and partnership dissolution, and potential barriers to interventions such as intimate partner violence (Aim 4). To our knowledge, the proposed study is the first prospective evaluation of FSWs and their non-commercial partners. Our binational research team is uniquely positioned to conduct this study, which will inform the response to the growing HIV crisis on the Mexico-US border and efforts to curtail HIV transmission among FSWs and their partners in other resource-constrained settings.