HIV prevalence and incidence in Israel is low and has been characterized by two transmission patterns, by homosexual and IDU transmission among native Israeli men, and by a heterosexually transmitted epidemic among Ethiopian Jews who immigrated in the 1990s. In the past 3 years, bacterial STD rates have increased substantially. These increases, coupled with development of a large transactional sex work industry, and the current Middle East conflict, and the current Middle East conflict have the potential to alter this pattern. There are currently an estimated 3,000 such transactional workers in Israel, with the majority located in the Tel Aviv metropolitan area, of whom an estimated 80% are illegal immigrants, predominantly area from the former Soviet Union. Clients are a mix of native Israelis and foreign workers. An initial STD/HIV prevalence study in 300 workers found high rates of STDs, but only 0.3% were HIV positive, and the Ministry of Health is opening a dedicated clinical in downtown Tel Aviv. HIV could be easily introduced and disseminated into the Tel Aviv population, but with the current low HIV seroprevalence aggressive interventions could be highly effective. In this I R03 project, we propose pilot formative and survey research in this population in Tel Aviv. We will perform 60 in depth ethnographic interviews in key informants and workers recruited from street outreach, from the clinic and from other venues. This will inform the development of a survey instrument, which will be used to interview 240 workers from each venue.
Our specific aims are: 1) To assess HIV/STD knowledge, awareness, and behaviors of workers; 2). To characterize the client mix 3) To examine how the legal status of these individuals, many of whom are illegal residents, impacts their access t health care and information, civil rights, safety, and working conditions; 4) To examine how social unrest and the Israel-Palestinian conflict impacts the transmission of HIV and STDs (e.g., through changes in migration patterns, disruptions in the provision of health education or services; 5) explore the feasibility of developing a cohort for longitudinal study. Interviews will be conducted in Russian or Hebrew, transcribed and analyzed using standard qualitative techniques. Data from this project will be used to evaluate efficacy of a new clinic, and to develop behavioral and/or structural interventions focused on HIV prevention.
| Giles, Julie A; Falconio, Jason; Yuenger, Jeffrey D et al. (2004) Quinolone resistance-determining region mutations and por type of Neisseria gonorrhoeae isolates: resistance surveillance and typing by molecular methodologies. J Infect Dis 189:2085-93 |
