HIV Risk among Latino Day Laborers: Structural, Social, and Individual Factors

描述（由申请人提供）：这项探索性研究（R21）涉及华盛顿外马里兰州郊区的男性、移民拉丁裔日工中的艾滋病毒风险。临时工在非正式市场（通常是户外）寻找工作，或者通过临时工作人员中介机构寻找工作。对这一人群的现有研究可以忽略不计，但有证据表明，拉丁美洲日工有感染艾滋病毒的风险。这项研究涉及乔治华盛顿大学和马里兰州，一个以社区为基础的组织服务拉丁美洲日工之间的伙伴关系。它是创新的，因为它调查个人特征及其对性风险行为的影响，在社会和结构背景下遇到的日工。这项研究具有公共卫生意义，因为它将导致有关性风险和艾滋病毒检测的障碍，在一个服务不足的弱势群体，其特点是延迟检测和晚进入护理的知识。具体目标是：1）描述影响华盛顿内马里兰州郊区男性、移民、拉丁裔日工的个人、社会和结构条件;并测试人口特征、文化特征、歧视经历和生活状况对性风险行为的影响; 2）研究社会和结构因素引起的条件如何影响酗酒和孤独，探讨酗酒和孤独对危险性行为的影响; 3）调查目标人群对HIV检测的态度和障碍。将使用定性和定量方法。关键信息提供者访谈（N = 10）、对日工（N = 10）和为其服务的女性性工作者（N = 5）的深入访谈以及对日工的焦点小组（2组，8至10名参与者; N = 20）将详细描述日工生活的社会和结构条件，并阐明形成风险行为和艾滋病毒检测障碍的多种因素。还将调查使用女性商业性工作者的模式和相关的性风险。一项定量调查，使用Audio-CASI（试验样本N = 20;全样本N = 175），将用于检验以下假设：1）可能由社会和结构条件引起的个体特征对性风险行为的影响; 2）孤独和酗酒作为此类特征影响的中介的作用; 3）不同类型的艾滋病毒检测障碍的重要性。由此产生的知识将有助于艾滋病毒预防工作的设计和未来的研究。它将确定可在多个层面解决的相关条件，包括通过针对个人的干预措施（例如，改变人们对艾滋病毒检测的态度），影响社区的社会项目（例如，创造建立联系的机会，从而减少社会孤立和孤独），以及政府制定的政策（例如，改善获得保健服务的机会）。公共卫生相关性：这项探索性研究将具有公共卫生意义，因为它将研究男性，移民拉丁美洲日工在他们生活的社会和结构背景下的个人艾滋病毒风险行为。此外，它还将使人们了解到，在服务不足的弱势群体中，艾滋病毒检测面临的障碍，这些群体的特点是检测延迟，接受护理的时间较晚。本研究将确定可在多个层面解决的相关条件，例如，通过针对个人的干预（例如，改变对艾滋病毒检测的态度），影响社区的社会项目（例如，创造建立联系的机会，从而减少孤立和孤独），以及政府制定的政策（例如，改善获得保健服务的机会）。

DESCRIPTION (provided by applicant): This exploratory study (R21) addresses HIV risk among male, migrant Latino day laborers in suburban Maryland, just outside Washington, DC. Day laborers seek work in informal markets (typically outdoors) or, less commonly, through temporary-work staffing agencies. There is negligible extant research on this population, but there is evidence to suggest that Latino day laborers are at risk for contracting HIV. This study involves a partnership between George Washington University and Casa de Maryland, a community-based organization serving Latino day laborers. It is innovative because it investigates individual characteristics and their impact on sexual risk behavior within the social and structural context encountered by day laborers. The study has public health significance because it will result in knowledge concerning sexual risk and barriers to HIV testing in an underserved and vulnerable group characterized by delayed testing and late entry to care. The specific aims are: 1) To describe individual, social, and structural conditions that affect male, migrant, Latino day laborers in the inner Maryland suburbs of Washington, DC; and to test the impact of demographic characteristics, cultural characteristics, experiences of discrimination, and living situation on sexual risk behavior; 2) To examine ways in which conditions arising from social and structural factors influence binge drinking and loneliness, and to explore the impact of binge drinking and loneliness on sexual risk behavior; and 3) To examine attitudes toward and barriers to HIV testing in the target population. Qualitative and quantitative methods will be used. Key informant interviews (N=10), in-depth interviews with day laborers (N=10) and female sex workers who serve them (N=5), and focus groups with day laborers (2 groups with 8 to 10 participants; N=20) will provide detailed descriptions of the social and structural conditions of day laborers' lives and will illuminate the multiple factors shaping risk behavior and barriers to HIV testing. Patterns of use of female commercial sex workers and associated sexual risks will also be investigated. A quantitative survey, administered with Audio-CASI (N=20 for pilot; N=175 for full sample), will be used to test hypotheses concerning 1) the impact on sexual risk behavior of individual characteristics that may arise from social and structural conditions; 2) the role of loneliness and binge drinking as mediators of the effects of such characteristics; and 3) the importance of different types of barriers to HIV testing. The resulting knowledge will be useful for the design of HIV prevention efforts and future research. It will identify relevant conditions that could be addressed at multiple levels, including through interventions aimed at individuals (e.g., to change people's attitudes about HIV testing), social programs affecting the community (e.g., to create opportunities to build bonds and thereby lessen social isolation and loneliness), and policies enacted by government (e.g., to improve access to health services). PUBLIC HEALTH RELEVANCE: This exploratory study will have public health significance because it will examine individual HIV risk behavior of male, migrant Latino day laborers within the social and structural contexts of their lives. Moreover, it will result in knowledge concerning barriers to HIV testing in an underserved and vulnerable group characterized by delayed testing and late entry to care. This study will identify relevant conditions that could be addressed at multiple levels, e.g., through interventions aimed at individuals (e.g., to change attitudes about HIV testing), social programs affecting the community (e.g., to create opportunities to build bonds and thereby lessen isolation and loneliness), and policies enacted by government (e.g., to improve access to health services).