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

描述（由申请人提供）：本研究的总体目标是研究两个墨西哥-美国边境城市高风险女性性工作者（FSWs）及其非商业男性伴侣的艾滋病毒，性传播感染和相关风险行为的背景和流行病学。我们的两国团队在过去5年中收集的初步数据表明，女服务员的非商业伙伴可能是HIV/STI感染和/或再次感染的重要驱动因素，这得到了其他国家文献的支持。在我们的环境中，女服务员与其主要非商业伴侣发生无保护性行为的可能性是其他人的两倍多；这些伙伴中有一半同时有伙伴关系，三分之一是注射吸毒者。本研究以蒂华纳和华雷斯的现有研究基础设施为基础，对fsw伴侣对（二对）进行研究，以实现以下目标：目标1：使用混合方法，研究a)背景和b)高风险fsw及其主要非商业男性伴侣在伙伴关系内外的高风险性行为和物质使用行为模式；目标2：确定艾滋病毒和特定性传播感染（即梅毒、淋病、衣原体、2型单纯疱疹病毒）及其相关因素在个人和伴侣层面的流行情况；目标3：前瞻性地确定性传播感染发生率的预测因素及其在个人和伴侣水平上的归因风险；目的4：采用混合方法，确定在a)伴侣水平和b)个人水平上对高风险fsw及其主要非商业男性伴侣进行行为干预试验的可行性。为了实现这些目标，我们将在蒂华纳和华雷斯Cd招募100名fsw伴侣（即200对夫妇），他们将在基线和随访24个月时接受访谈和艾滋病毒/性传播感染检测，以解决临床和行为结果（目标2和3）。一个子集（每个城市25对夫妇）将在基线和随访期间进行一次深入访谈，以完善定量调查，并为实现目标1和4的混合方法分析提供信息。使用定性和定量方法，我们将评估每个伴侣参与后续干预的兴趣，流失和伙伴关系解散，以及干预的潜在障碍，如亲密伴侣暴力（目标4）。据我们所知，拟议的研究是首个对渔护所及其非商业伙伴进行前瞻性评估的研究。我们的两国研究团队在开展这项研究方面具有独特的优势，这将为应对美墨边境日益严重的艾滋病毒危机提供信息，并为在其他资源受限的环境中减少fsw及其合作伙伴之间的艾滋病毒传播提供信息。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The proposed study of FSW-partner pairs in Tijuana and Ciudad Juarez will meet the following aims: Aim 1: To examine the a) social 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.