Pilot Award Recipient: Jennifer Huang Bouey, MBBS, PhD, MPH

Although conventional wisdom ties drug use and sexual risks to younger populations, the incidence of both HIV and drug abuse have reportedly shown the greatest increase among China's growing middle-aged population (40-60 years old). Several studies have documented indications of high sexual risks among these target populations from different perspectives. For example, a cross-sectional study of 11,461 STI patients in China found that 46% of patients at least 50 years old acknowledged purchasing commercial sex, while less than 4% acknowledged using condoms.9 Older clients are more likely to frequent streetwalkers, who compared to other types of sex workers are at the bottom of the sex work hierarchy, tend to be older, less educated, lower-paid, less likely to use protection during sexual transactions, and have a higher prevalence of syphilis (ranging from 10-38%) and other STIs. Strategies to prevent HIV/STI infection and drug use are generally ineffective among this population since they are primarily designed to target younger populations and traditional injection drug users. Thus, appropriate intervention strategies must be developed to target this high-risk population. To do so, it is critical to establish reliable and valid data regarding their determinants of risk and the context in which these determinants occur. The proposed 12-month pilot study will build upon our current R21 study (funded by NICHD/NIH) characterizing peer social networks and sexual health among female streetwalkers in Shanghai, China. Our multi-institutional and interdisciplinary team is based upon collaboration among experts from behavioral epidemiology, psychology, anthropology, community participatory research, and clinical medicine, and has been prolific in conducting and publishing HIV behavioral research among both male and female sex workers in Shanghai. These projects particularly benefit from collaboration between academic institutes in China (Fudan University) and the US (Georgetown and George Washington University), and US and Chinese government agencies (US CDC and China CDC). This new application will allow us to broaden our research from a specific focus on sexual health to include patterns and determinants of substance abuse. We will apply the tried-and-tested model of International Rapid Assessment, Response and Evaluation (I-RARE) to describe the sexual and drug-use HIV risk behaviors of streetwalkers and their clients in Shanghai within a short period.