The Caribbean region has the second highest prevalence rates of HIV in the world following sub-Saharan Africa and is one of the region's most affected by illicit drug use and drug trafficking. Focusing on men's changing work, migration, and sexual and drug use behavior in the Dominican Republic, the proposed mixed- methods collaborative study examines how HIV risk and drug use among migrant men are related to (1) patterns of migration and (2) the social environments of tourism areas. We relate contemporary demographic changes to HIV and drug use practices through the notion of tourism ecologies - geographically constrained areas in which five ecological features (social isolation;social stigma;business norms;touristic escapism;and drug and alcohol availability) are hypothesized to contribute to high risk behaviors. Our research relies fundamentally on a long-standing multisectoral Community Advisory Board involving private tourism representatives, government, public health officials, and civil society. Data collection consists o: (1) semi- structured interviews with 36 systematically selected male migrant workers in two coastal tourism areas (two interviews per subject = 72 sessions);(2) ethnographic mapping and spatial analysis using Arc-GIS in two tourism areas;(3) a cross-sectional survey with 400 male migrant workers in two research sites;and (4) the implementation of a pilot intervention with 40 migrant male tourism workers. This study contributes to public health knowledge and health promotion in three key ways. First, it identifies the factors in tourism areas that most contribute to HIV risk and drug use, contributing to the development and piloting of an evidence-based intervention. Second, it draws on an extensive literature to systematically analyze the health effects of tourism environments in high-risk settings for HIV and drug use. Finally, it incorporate a participatory process to research that will strengthen local relevance, research translation, and the impact on health policies and programs.
The primary objectives of this research are to determine whether and how HIV risk and drug use in the Dominican Republic are related to the social environments of tourism areas and patterns of male labor migration to these areas, and to develop and pilot an intervention to reduce HIV and drug use risk among Dominican male tourism migrants. If the project describes how tourism ecologies are related to HIV risk and drug use in this high prevalence nation, subsequent prevention interventions can be scientifically tested to mitigate these risks in both the Dominican Republic and other high prevalence Caribbean countries.