Gender-based violence, social cohesion, and engagement in HIV care among female-sex workers in Iringa, Tanzania: A mixed methods approach

 描述（由申请人提供）：撒哈拉以南非洲（SSA）的女性性工作者（FSW）受到艾滋病毒的影响不成比例，并在该地区持续的传播动态中发挥关键作用。基于性别的暴力（GBV）可能会促进FSW及其性伴侣之间的艾滋病毒感染和传播。过去的研究已经确定了性别暴力对SSA中FSW性风险行为的负面影响。我们的研究解决了有限的知识GBV对艾滋病毒感染的FSW之间的艾滋病毒护理和治疗服务的利用，以及社会凝聚力可能会影响这种关系。这些行为对于确保HIV感染者的健康和福祉，以及降低向未感染HIV的伴侣传播的风险是必要的。通过从坦桑尼亚伊林加的艾滋病毒感染的FSW的样本，拟议的研究的目的是调查性别暴力，社会凝聚力和参与艾滋病毒护理之间的关系，这一人口。具体而言，本研究旨在评估性别暴力和参与艾滋病毒护理之间的关系，并探讨社会凝聚力如何改变这种关系。拟议的研究将使用来自父母NIMH/NIAID赞助的FSW社区联合预防研究的定量基线调查数据。我们还将进行定性的深入访谈，以探讨感染艾滋病毒的女性性工作者的观点和经验，他们经历了性别暴力，关于社会凝聚力在获得和保留艾滋病毒护理和治疗方面的作用。最后，通过一个平行的混合方法设计，我们将评估如何收敛的定量和定性的结果，以获得一个全面的了解的作用，社会凝聚力在艾滋病毒感染的FSW谁经历了GBV的艾滋病毒服务利用。拟议的研究提供了一个与强大的导师团队合作的机会，该团队由各自领域的领导者组成，以建立先进的数据分析，社会理论和混合方法的技能，同时解决NIMH的艾滋病毒研究重点和战略目标。调查结果将促进对性别暴力在从事性工作者之间的艾滋病毒护理的作用的知识，并最终告知在SSA和全球性的性工作者之间的综合性性别暴力和艾滋病毒治疗干预措施的发展。

 DESCRIPTION (provided by applicant): Female sex workers (FSWs) in sub-Saharan Africa (SSA) are disproportionately affected by HIV and play a key role in ongoing transmission dynamics in the region. Gender based violence (GBV) may promote in HIV acquisition and transmission among FSWs and their sexual partners. Past studies have established the negative effect of GBV on sexual risk behaviors among FSWs in SSA. Our study addresses the limited knowledge regarding the effect of GBV on utilization of HIV care and treatment services among HIV-infected FSWs, and how social cohesion may influence this relationship. These behaviors are necessary for ensuring the health and wellbeing of the HIV infected individual, and reducing the risk of transmission to an HIV uninfected partner. Through a sample of HIV-infected FSWs from Iringa, Tanzania, the purpose of the proposed research is to investigate the relationship between GBV, social cohesion and engagement in HIV care among this population. Specifically, this study aims to assess the relationship between GBV and engagement in HIV care, and explore how social cohesion may modify this relationship. The proposed research will use quantitative baseline survey data from a parent NIMH/NIAID-sponsored community-based combination prevention study among FSWs. We will also conduct qualitative in-depth interviews to explore the perspectives and experiences of HIV-infected FSWs who have experienced GBV regarding the role social cohesion plays in access and retention in HIV care and treatment. Finally, through a parallel mixed methods design, we will assess how the quantitative and qualitative results converge in order to gain a comprehensive understanding of the role social cohesion plays in HIV service utilization among HIV-infected FSWs who have experienced GBV. The proposed research offers an opportunity to work with a strong mentorship team, comprised of faculty members who are leaders in their fields, to build skills in advanced data analysis, social theory and mixed methods, while simultaneously addressing NIMH's HIV research priorities and strategic goals. Findings will advance knowledge regarding the role of GBV in engagement in HIV care among FSWs and ultimately inform the development of integrated GBV and HIV treatment interventions among FSWs in SSA and globally.