SYRINGE ACCESS AND RISK FACTORS ON HIV TRANSMISION

描述：（申请人摘要） 注射毒品占美国艾滋病病例的近三分之一 国家通过直接或间接传播给其他注射毒品 使用者，他们的性伴侣和后代。 1996年，在有 保密的艾滋病毒检测、注射毒品或与他人发生性接触 注射吸毒者分别占新吸毒者的35%和86%， 报告了其风险类别的男性和女性的艾滋病毒检测呈阳性。 在 作为回应，美国国家科学院在1995年建议， 在美国，注射毒品使用者的预防策略应该 包括针具交换计划和解除处方管制， 用具法。 美国的一些州（如康涅狄格州）已经 已经执行了这两项建议，更多的国家正在这样做。 尽管通过已建立的针头广泛获得无菌注射器 交流计划和药房访问，最近有证据表明，艾滋病毒的高 蒙特利尔注射毒品使用者的感染率（每年5%）， 温哥华（每年19%）。 本研究的目的是为了遵循 确定血清发病率趋势的队列，并确定因素， 解释人口中艾滋病毒感染率升高的过程 注射毒品使用者可以使用无菌注射设备。 的 正在研究的主要假设是，一个复杂的因素关系， 社会层面和过程，包括毒品的类型、 药物使用，使用者周围的微观社会气候，宏观社会环境 吸毒社区的气氛和态度因素 无菌注射设备的次优利用情况， 这反过来又影响到注射吸毒者中艾滋病毒发病率 人口。 我们假设这些因素和过程可能是如此强大， 他们可以超过针头交换和法律的保护作用 药房准入。 这项研究将使用定量（流行病学） 队列）和定性（生活史访谈，民族志）方法 研究温哥华的注射毒品使用者群体， 蒙特利尔 研究的两个中心性质将允许在 以及这些城市之间的联系，以确定共同和不同的风险 与次优注射器相关的因素、保护因素和过程 艾滋病毒感染的风险增加。 解释仅针头可及性不足以 制止艾滋病毒在注射吸毒人群中传播至关重要 重要性 这些发现可能有助于美国的司法管辖区， 在其他地方，以避免重复我们最近的经验。

DESCRIPTION: (Applicant's Abstract) Injection drug use accounts for nearly one third of AIDS cases in the United States through direct or indirect transmission to other injection drug users, their sexual partners and offspring. In 1996, in states with confidential HIV testing, injection drug use or sexual contact with an injection drug user accounted for 35% and 86% respectively, of new HIV-positive tests in men and women whose risk category was reported. In response, the National Academy of Sciences recommended in 1995, that HIV prevention strategies among injection drug users in the United States should include both needle exchange programs and deregulation of prescription and paraphernalia laws. Some U.S. states (e.g. Connecticut) have already implemented both these recommendations, and more are on the way to doing so. Despite widespread access to sterile syringes through established needle exchange programs and pharmacy access, there is recent evidence of high HIV infection rates among injection drug users in Montreal (5% per year) and Vancouver (19% per year). The purpose of this study is to follow well established cohorts for trends in seroincidence and to identify factors and processes which explain these elevated HIV infection rates among populations of injection drug users who have access to sterile injection equipment. The major hypothesis under study is that a complex relationship of factors, social dimensions and processes including the type of drug, the pattern of drug use, the micro social climate surrounding the user, the macro-social climate in the drug using community, and attitudinal factors create situations of sub-optimal utilization of sterile injection equipment, which in turn impact upon HIV incidence rates among injection drug using populations. We hypothesize these factors and processes may be so potent that they can outweigh the protective effects of needle exchange and legal pharmacy access. The study will use both quantitative (epidemiologic cohort) and qualitative (life-history interviews, ethnography) methodologies to study well-established groups of injection drug users in Vancouver and Montreal. The two site nature of the study will allow comparisons within and between these cities in an effort to identify common and divergent risk factors, protective factors and processes related to sub-optimal syringe utilization and increased risk of HIV infection. Explaining the reasons why needle accessibility alone is not sufficient to halt HIV transmission in injection drug using populations is of paramount importance. Such findings could help jurisdictions in the U.S. and elsewhere to avoid a repeat of our recent experience.