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

描述（由申请人提供）：本探索性研究（R21）探讨了华盛顿特区外马里兰州郊区拉丁裔男性移民日工的艾滋病毒风险。日工在非正式市场（通常是户外）找工作，或者不太常见的是通过临时工作的人力资源机构找工作。对这一人群的现有研究可以忽略不计，但有证据表明拉丁裔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Casa de Maryland之间的合作，Casa de Maryland是一个为拉丁裔日工服务的社区组织。它的创新之处在于它调查了个体特征及其在日工遇到的社会和结构背景下对性风险行为的影响。这项研究具有公共卫生意义，因为它将使人们了解服务不足和弱势群体的性风险和艾滋病毒检测障碍，这些群体的特点是检测延迟和获得护理较晚。具体目标是：1)描述影响华盛顿特区马里兰州内郊区男性、移民、拉丁裔日工的个人、社会和结构条件；检验人口特征、文化特征、受歧视经历、生活状况对性危险行为的影响；2)研究社会和结构因素对酗酒和孤独感的影响，探讨酗酒和孤独感对性危险行为的影响；3)调查目标人群对HIV检测的态度和障碍。将采用定性和定量方法。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）的深度访谈，以及对日工的焦点小组访谈（2组，8 - 10人；N=20）将详细描述日工生活的社会和结构条件，并阐明影响风险行为和艾滋病毒检测障碍的多重因素。还将调查使用女性商业性工作者的模式和相关的性风险。使用音频- casi进行的定量调查（试点N=20，全样本N=175）将用于检验以下假设：1)社会和结构条件可能引起的个体特征对性风险行为的影响；2)孤独感和狂饮对这些特征影响的中介作用；3)不同类型艾滋病毒检测障碍的重要性。由此产生的知识将有助于设计艾滋病毒预防工作和未来的研究。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）、影响社区的社会方案（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，因为它将在其生活的社会和结构背景下检查男性拉丁裔移民日工的个人艾滋病毒风险行为。此外，它还将使人们了解在服务不足的弱势群体中进行艾滋病毒检测的障碍，这些群体的特点是检测延迟和获得护理较晚。这项研究将确定可以在多个层面上解决的相关条件，例如，通过针对个人的干预措施（例如，改变对艾滋病毒检测的态度），影响社区的社会方案（例如，创造机会建立联系，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).