Theorizing "Big Events" as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks
Theorizing "Big Events" as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks
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DOI：
10.1016/j.drugpo.2008.10.006
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发表时间：
2009-05-01
影响因子：
4.4
通讯作者：
Braine, Naomi
中科院分区：
文献类型：
--
作者：
Friedman, Samuel R.;Rossi, Diana;Braine, Naomi
在苏联、印度尼西亚和中国(而不是菲律宾)的政治经济转型之后，吸毒者中出现了艾滋病毒流行。战争有时也可能增加艾滋病毒的风险。基于战争和过渡可能影响艾滋病毒风险的一些因果途径的相似性，我们使用“重大事件”一词来包括这两种情况。我们首先批评了几个先前的重大事件流行病学模型，认为它们没有充分纳入社会因素，而且在社会学中有些不精确和过于笼统。然后，我们建议了一个使用以下概念的模型：首先，特定于事件的艾滋病毒传播概率是(A)伴侣感染不协调的概率；(B)未感染伴侣的感染易感性；(C)感染者的传染性--以及(D)所从事的行为的函数。这些概率取决于艾滋病毒和其他变量在人群中的分布。性或注射事件纳入了危险行为，并植根于性和注射伙伴关系模式和社区网络，而这些模式又受社区规范性监管内容的影响。战争和过渡可以改变社会经济变数，这些变数有时会导致参与高风险毒品和性网络和行为的人数以及他们所做的事情的风险增加。重大事件影响的这些变量可能包括：人口流离失所；经济困难和政策；警察腐败、压抑和未能维持秩序；保健服务；移徙：社会运动；性别角色；以及族群间暴力--这些反过来又影响规范管理、青年疏远、网络和行为。作为这些途径的一部分，邻里居民、青少年、吸毒者和性工作者为维护他们的经济福利、健康或幸福而采取的自主行动可能会影响这些变量中的许多变量，或者以其他方式调节艾滋病毒流行是否遵循过渡。因此，我们认为，研究这些相互作用的因果路径和自主行动是否以及如何伴随着与药物有关的伤害和/或艾滋病毒或其他流行病，可以帮助LIS了解如何干预以预防或减轻此类伤害。(C)2008爱思唯尔B.V.保留所有权利。
Political-economic transitions in the Soviet Union, Indonesia, and China, but not the Philippines, were followed by HIV epidemics among drug users. Wars also may sometimes increase HIV risk. Based on similarities in some of the causal pathways through which wars and transitions can affect HIV risk, we use the term "Big Events" to include both. We first critique several prior epidemiological models of Big Events as inadequately incorporating social agency and as somewhat imprecise and over-generalizing in their sociology. We then suggest a model using the following concepts: first, event-specific HIV transmission probabilities are functions of(a) the probability that partners are infection-discordant; (b) the infection-susceptibility of the uninfected partner; (c) the infectivity of the infected-as well as (d) the behaviours engaged in. These probabilities depend on the distributions of HIV and other variables in populations. Sexual or injection events incorporate risk behaviours and are embedded in sexual and injection partnership patterns and community networks, which in turn are shaped by the content of normative regulation in communities. Wars and transitions can change socio-economic variables that can sometimes precipitate increases in the numbers of people who engage in high-risk drug and sexual networks and behaviours and in the riskiness of what they do. These variables that Big Events affect may include population displacement; economic difficulties and policies; police corruption, repressiveness, and failure to preserve order; health services; migration: social movements; gender roles; and inter-communal violence-which, in turn, affect normative regulation, Youth alienation, networks and behaviours. As part of these pathways, autonomous action by neighbourhood residents, teenagers, drug users and sex workers to maintain their economic welfare, health or happiness may affect many of these variables or otherwise mediate whether HIV epidemics follow transitions. We thus posit that research on whether and how these interacting causal pathways and autonomous actions are followed by drug-related harm and/or HIV or other epidemics can help LIS understand how to intervene to prevent or mitigate such harms. (C) 2008 Elsevier B.V. All rights reserved.