HIV RISK AND TRANSITIONS FROM NONINJECTING HEROIN USE

在过去的几年里，非注射性使用 海洛因仅在纽约市，就有数万名非注射毒品者 （NIU）的海洛因有很高的风险恢复或开始注射 吸毒并最终感染人类 免疫缺陷病毒（HIV）和其他血液传播的病原体。他们还 有可能因从事不安全的性行为而受到感染。人中 继续注射的人，一些新的注射者可能会特别增加 在注射早期感染艾滋病毒的风险 careers.由于对海洛因NIU知之甚少， 将提供有助于制定政策和方案的知识， 防止海洛因未成年人过渡到注射毒品，以鼓励 停止注射，并防止他们从事不安全的 性 研究的第一个也是最重要的目的是确定， 海洛因NIU谁不是目前的注射者，他们的速度， 发展/恢复注射吸毒，以及这种情况的预测因素 进展/逆转。其他目的是确定：（2）范围和 高风险性行为和高风险性网络的预测因子，以及 高危性行为和高危性网络的变化;（3） 在那些成为注射者的人中， 高风险的注射行为和高风险的毒品网络， 这些行为和网络的预测因素;（4）程度和预测因素 艾滋病毒、B型肝炎（HBV）和丙型肝炎（HCV）的流行感染率 （五）有无吸毒史; 感染HIV、HBV和HCV的发病率，以及 在继续注射和不继续注射的人中，乙型肝炎病毒和丙型肝炎病毒感染。 这项研究将是一项前瞻性队列研究，在新的1,300名海洛因NIU中进行。 约克，将从多个非治疗环境中招募。他们 将接受面试和测试，并在 六个月的间隔。将分析这些数据，以确定 使用嵌套病例对照技术的转换和发生率， 人-年方法，如考克斯比例风险回归。 将通过实地观察收集人种学数据， 密集的采访，并将使用扎根理论进行分析 技术. 分析的重点将放在确定具体原因， 或者说，他们是在为一个人而奋斗，或者说，为一个人而奋斗。 开始/恢复注射，导致特别高风险的因素 行为或在特别高风险的网络中注射毒品）。 可能的原因包括：（1）特定类型的社会关系， 包括社会支持网络和风险网络;（2）具体的 社会融合或边缘化的类型;（3）个人 敏感性因素;和（4）药物市场条件如纯度， 可用性和成本。 在此基础上，提出了相应的建议和对策 开发用于防止NIU进展/恢复为注射。等 这些项目可以拯救成千上万的生命。

In the last few years there has been a resurgence in non-injecting use of heroin. In New York City alone, tens of thousands of non-injecting users (NIUs) of heroin are at high risk of reverting to or initiating injecting drug use and of eventually becoming infected with the human immunodeficiency virus (HIV) and other blood-borne pathogens. They also are at risk of becoming infected by engaging in unsafe sex. Among those who go on to inject, some new injectors may be at particularly increased risk of infection with HIV during the early part of their injection careers. Since little is known about heroin NIUs, the proposed research will provide knowledge which can help to develop policies and programs to prevent transitions to drug injecting by heroin NIUs, to encourage those who start to inject to stop, and to prevent them from engaging in unsafe sex. The first and most important aim of the research is to determine, among heroin NIUs who are not current injectors, the rate at which they progress/revert to injecting drug use, and the predictors of such progression/reversion. Other aims are to determine: (2) the extent of and predictors of high-risk sexual behavior and high-risk sexual networks, and of changes in high-risk sexual behavior and high-risk sexual networks; (3) among those who become injectors, the extent to which they then engage in high-risk injecting behaviors and have high-risk drug networks, and the predictors of such behaviors and networks; (4) the extent and predictors of prevalent infection with HIV, hepatitis B (HBV) and hepatitis C (HCV) among those who have and have not previously injected drugs; and (5) the incidence rates of infection with HIV, HBV and HCV, and the predictors of HBV and HCV infection, among those who do and do not go on to inject. The study will be a prospective cohort study of 1,300 heroin NIUs in New York who will be recruited from multiple out-of-treatment settings. They will be interviewed and tested, and given three follow-up interviews at six month intervals. These data will be analyzed for predictors of transitions and incidence rates using nested case-control techniques and person-years methods such as Cox proportional hazards regression. Ethnographic data will be collected through field observation and intensive interviews, and will be analyzed using grounded theory techniques. Analytic emphasis will be placed on determining specific causes that induce or restrain NIUs from injecting (and among those who do begin/revert to injecting, factors that lead to particularly high-risk behaviors or to injecting drugs in particularly high-risk networks). Possible causes include: (1) specific kinds of social relationships, including both social support networks and risk networks; (2) specific kinds of social integration or marginalization; (3) personal susceptibility factors; and (4) drug market conditions such as purity, availability and cost. On the bases of these analyses, suggestions and proposals will be developed to prevent NIUs from progressing/reverting to injecting. Such programs could literally save tens of thousands of lives.