The overall goal of the proposed dissertation research project (R36) is to conduct a cross-sectional mixed methods study of sexual partner concurrency (i.e., overlapping sexual partnerships), an important factor in the epidemiology of HIV and other sexually transmitted infections (STIs), among dyads of high-risk, drug using female sex workers (FSWs) and their non-commercial, intimate male partners in the U.S.-Mexico border region. Substance abuse, sex work, and population mobility are features of the region, where a dynamic epidemic of HIV/STIs has emerged in high-risk populations including FSWs and injection drug users (IDUs). Although to date these HIV/STI epidemics remain concentrated, concurrency among FSW-intimate partner dyads could rapidly promote the "bridging" of HIV/STIs to the general population. Despite the vast literature on concurrency, little is known about the motivations for and contexts surrounding concurrency among marginalized, drug-using dyads in resource-poor settings in the Western Hemisphere. The proposed dissertation study seeks to characterize the social context of concurrency for high-risk dyads (Aim 1) and determine the gender-specific prevalence and correlates of concurrency among high-risk FSWs (Aim 2) and their intimate male partners (Aim 3) in the U.S.-Mexico border region. To meet these aims, we will implement a cross-sectional mixed methods design using qualitative and quantitative methods within Proyecto Parejas (R01-DA02772;PI: S. Strathdee), an existing cohort of 200 dyads of high-risk, drug-using FSWs and their intimate male partners in Tijuana and Cd. Juarez (N=400 subjects total). To meet Aim 1, we will purposively sample ~20 women and ~20 men (N=40) reporting recent (past year) concurrency in existing baseline quantitative surveys that measured concurrency using a UNAIDS-recommended sexual partner history module. We will conduct semi-structured interviews with this subsample, which will be distinct from data collection of the parent study, to qualitatively explore the meanings of and motivations for concurrency including social and environmental factors that may promote or discourage concurrency behaviors. We will then use emergent qualitative findings to develop a conceptual framework and specific hypotheses to guide quantitative analyses. To meet Aims 2 and 3, we will use existing quantitative baseline data from the entire cohort of 200 dyads (N=400). We will determine concurrency prevalence and apply multilevel (i.e., dyadic) logistic regression to identify individual- and relationship-level correlates of concurrency for FSWs (Aim 2) and their intimate male partners (Aim 3). Our dyadic, mixed methods study design will provide the first in-depth investigation of concurrency in a region characterized by prevalent drug use, commercial sex, and population mobility. It will also position the PI as a competitive new investigator in drug abuse research. Findings will be critical to the development of evidence-based, gender-specific interventions to reduce HIV/STI risk among drug-using FSWs and their intimate male partners.

Public Health Relevance

The proposed dissertation research project (R36) will provide important insight into the role of sexual partner concurrency (i.e., overlapping sexual partnerships), an important factor in the epidemiology of HIV and other sexually transmitted infections (STIs), among dyads of high-risk, drug-using female sex workers (FSWs) and their non-commercial, intimate male partners in the U.S.-Mexico border region. Although HIV/STIs in this region remain concentrated among FSWs and injection drug users (IDUs), concurrency among FSWs and their intimate male partners could promote the bridging of HIV/STIs to the general population. The proposed use of quantitative and qualitative research methods within an existing cohort (Proyecto Parejas;R01-DA02772;PI: S. Strathdee) will provide the first in-depth examination of the gender-specific prevalence, correlates, and social contexts of concurrency in a resource-poor setting in the Western Hemisphere, leading to important HIV- prevention intervention implications and positioning the PI as a competitive new investigator in the field of drug abuse research.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Dissertation Award (R36)
Project #
5R36DA032376-02
Application #
8311620
Study Section
Special Emphasis Panel (ZRG1-AARR-K (03))
Program Officer
Hartsock, Peter
Project Start
2011-08-15
Project End
2013-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
2
Fiscal Year
2012
Total Cost
$52,942
Indirect Cost
$3,922
Name
University of California San Diego
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Stockman, Jamila K; Syvertsen, Jennifer L; Robertson, Angela M et al. (2014) Women's perspectives on female-initiated barrier methods for the prevention of HIV in the context of methamphetamine use and partner violence. Womens Health Issues 24:e397-405
Pinedo, Miguel; Burgos, José Luis; Robertson, Angela M et al. (2014) Perceived risk of HIV infection among deported male injection drug users in Tijuana, Mexico. Glob Public Health 9:436-54
Palinkas, Lawrence A; Robertson, Angela M; Syvertsen, Jennifer L et al. (2014) Client perspectives on design and implementation of a couples-based intervention to reduce sexual and drug risk behaviors among female sex workers and their noncommercial partners in Tijuana and Ciudad Juárez, México. AIDS Behav 18:583-94
Syvertsen, Jennifer L; Robertson, Angela M; Strathdee, Steffanie A et al. (2014) Rethinking risk: gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border. Int J Drug Policy 25:836-44
Robertson, Angela M; Syvertsen, Jennifer L; Ulibarri, Monica D et al. (2014) Prevalence and correlates of HIV and sexually transmitted infections among female sex workers and their non-commercial male partners in two Mexico-USA border cities. J Urban Health 91:752-67
Robertson, Angela M; Syvertsen, Jennifer L; Amaro, Hortensia et al. (2014) Can't buy my love: a typology of female sex workers' commercial relationships in the Mexico-U.S. Border Region. J Sex Res 51:711-20
Gaines, Tommi L; Rusch, Melanie L A; Brouwer, Kimberly C et al. (2013) Venue-level correlates of female sex worker registration status: a multilevel analysis of bars in Tijuana, Mexico. Glob Public Health 8:405-16
Syvertsen, Jennifer L; Robertson, Angela M; Rolon, Maria Luisa et al. (2013) "Eyes that don't see, heart that doesn't feel": coping with sex work in intimate relationships and its implications for HIV/STI prevention. Soc Sci Med 87:1-8
Robertson, Angela Marie; Syvertsen, Jennifer L; Rangel, M Gudelia et al. (2013) Concurrent sexual partnerships among female sex workers and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. Sex Transm Infect 89:330-2
Syvertsen, Jennifer L; Robertson, Angela M; Abramovitz, Daniela et al. (2012) Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research. BMC Public Health 12:136

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