Epidemiologic Study on Changing HIV Risks Among FSW-IDUs on the Mexico-US Border

描述（由申请人提供）：在全球范围内，注射毒品的性工作者（FSW-IDUs）是重要的“桥梁”人群，可以将艾滋病毒/性传播感染传播给一般人群;然而，缺乏减少其注射和性风险的干预措施。这项流行病学研究的总体目标是同时减少两个墨西哥-美国边境城市的FSW-注射吸毒者的高风险性行为和注射行为，其中艾滋病毒流行率最近从2%上升到14%; 46%至少有一次活动性STI。我们的具体目标是：目的1）评价行为干预对减少暗娼吸毒者共用注射器和注射器具的效果。我们假设，处于积极实验性注射风险降低条件下的FSW-IDUs将报告：（a）较少接受和分配针头共享;（B）较少共享注射用具;（c）从更安全的来源获得注射器和注射用具。目的2）评估在持续吸毒的背景下，增加FSW-IDUs中安全套使用的行为干预的效果。我们假设，在积极的实验性性风险降低条件下，FSW-IDUs将：（a）报告更少的无保护阴道和肛交;（B）有更少的特定性传播感染的事件病例。目的3）评价这两种行为干预措施对增加安全套使用和减少共用针头/注射用具的联合作用。我们假设，这些干预措施的联合作用将产生更大的风险降低相比，单独干预。目标4）确定我们干预措施的理论上重要的组成部分（即，自我效能、结果预期、态度、意图）代表了主要结果变化的潜在机制（即，性和注射相关的风险降低）。目的5）探讨基于背景特征、背景因素、社会因素和个人因素的a）性风险降低干预和B）注射风险降低干预的亚组差异。为了实现这些目标，我们将招募600名艾滋病毒阴性的FSW-IDUs（在蒂华纳和镉各300名）。Juarez），并将女性随机分为三个时间相当的组之一（第1组：注射风险干预和教学式安全性教育;第2组：性风险干预和教学式安全注射教育;第3组：主动注射和性干预）。在每个城市，将采用分组随机化方法，以尽量减少污染。所有妇女都接受免费的性传播感染治疗，并将在4个月、8个月和12个月时接受随访。我们的设计使我们能够“解开”干预措施，以确定其组成部分是否同样有效地减少注射和/或性风险，或者是否需要更密集的条件来改变艾滋病毒/性传播感染的流行病学，从而对墨西哥和美国产生直接，切实的政策影响。减少FSW-IDUs中艾滋病毒风险的干预措施可能会遏制美国-墨西哥边境地区迅速蔓延的艾滋病毒流行病，并适用于其他资源贫乏的国家。在全球范围内，FSWs谁注射毒品（FSW-IDUs）是重要的“桥梁”人口，可以将艾滋病毒/性传播感染给一般人群;然而，缺乏干预措施，以减少他们的注射和性风险。这项流行病学研究的总体目标是同时减少两个墨西哥-美国边境城市的FSW-注射吸毒者中的高风险性行为和注射行为，其中艾滋病毒流行率最近急剧增加。据我们所知，这是在任何国家进行的第一次此类研究，其研究结果与资源有限的环境特别相关。

DESCRIPTION (provided by applicant): Globally, FSWs who inject drugs (FSW-IDUs) are important `bridge' populations that can transmit HIV/STIs to the general population; however, interventions to reduce both their injection and sexual risks are lacking. The overall goal of this epidemiologic study is to simultaneously reduce high risk sexual and injection behaviors among FSW-IDUs in two Mexico-U.S. border cities, among whom HIV prevalence has recently increased from 2% to 14%; 46% had at least one active STI. Our specific aims are: Aim 1) To evaluate the efficacy of a behavioral intervention to decrease sharing of syringes and injection paraphernalia among FSW-IDUs. We hypothesize that FSW-IDUs in the active experimental injection risk reduction condition will report: (a) less receptive and distributive needle sharing; (b) less sharing of injection paraphernalia; (c) obtaining syringes and injection paraphernalia from safer sources. Aim 2) To evaluate efficacy of a behavioral intervention to increase condom use among FSW-IDUs in the context of ongoing drug use. We hypothesize that FSW-IDUs in the active experimental sexual risk reduction condition will: (a) report less unprotected vaginal and anal sex; (b) have fewer incident cases of specific STIs. Aim 3) To evaluate the joint effects of these two behavioral interventions to increase condom use and reduce sharing of needles/injection paraphernalia among FSW- IDUs. We hypothesize that the joint effect of these interventions will generate greater risk reductions compared to either intervention alone. Aim 4) To determine the extent to which theoretically-important components of our interventions (i.e., self-efficacy, outcome expectancies, attitudes, intentions) represent underlying mechanisms of change in primary outcomes (i.e., sexual and injection-related risk reductions). Aim 5) To explore subgroup differences in the efficacy of a) the sexual risk reduction intervention and b) the injection risk reduction intervention based on background characteristics, contextual factors, social factors and intrapersonal factors. To meet these aims, we will recruit 600 HIV-negative FSW-IDUs (300 each in Tijuana and Cd. Juarez) and randomize women to one of three time-equivalent groups (Group 1: injection risk intervention and didactic safer sex education; Group 2: sexual risk intervention and didactic safer injection education; Group 3: Both active injection and sexual interventions). In each city, cluster randomization will be used to minimize contamination. All women receive free STI treatment and will be followed-up at 4, 8 and 12 months. Our design allows us to `unpack' the intervention to determine whether its components are just as effective in reducing injection and/or sexual risks, or if the more intensive conditions are needed to alter the epidemiology of HIV/STIs, thus having direct, tangible policy implications for Mexico and the US. Interventions that reduce HIV risks among FSW-IDUs may curtail the burgeoning HIV epidemic in the U.S-Mexico border region, and have applicability to other resource-poor countries.Globally, FSWs who inject drugs (FSW-IDUs) are important `bridge' populations that can transmit HIV/STIs to the general population; however, interventions to reduce both their injection and sexual risks are lacking. The overall goal of this epidemiologic study is to simultaneously reduce high risk sexual and injection behaviors among FSW-IDUs in two Mexico-U.S. border cities, among whom HIV prevalence has recently increased dramatically. To our knowledge, this is the first study of its kind to be tested in any country, findings from which have particular relevance to resource-constrained environments.