NATIONAL STUDY OF SYRINGE EXCHANGE PROGRAMS

在美国，许多新的艾滋病毒感染(如果不是大多数的话)都发生在静脉注射吸毒者(IDUs)及其性伴侣中。三种类型的计划已被证明在减少该人群中的艾滋病毒危险行为方面是有效的：社区外展、药物滥用治疗和注射器交换计划(SEP)。已经对社区外展和药物滥用治疗计划进行了全国性的评估，但值得注意的是，没有对美国SEP的状况进行类似的评估。这项拟议的研究试图填补这一空白。建议的研究针对以下具体目标：(1)描述在美国运营的SEP的组织特征，并描述这些计划随时间的变化；(2)评估SEP参与者的人口特征和风险行为；(3)确定与持续或持续的风险行为相关的个人层面因素；(4)确定与参与者中的风险相关的SEP组织特征；(5)检查SEP特征与参与者风险行为变化之间的关系；以及(6)估计大型SEP参与者中的艾滋病毒发病率。为了实现这些目标，我们将每年对目前在美国运营的SEP的董事进行电话调查。这将提供有关SEP实施、SEP的组织特征以及SEP提供的服务的最新信息。我们还将对6家大型SEP和18家中型SEP的参与者进行25920次分层随机抽样访问。抽样的程序将代表美国所有SE活动的大约一半。抽样将受到限制，以提供地理代表性和方案所服务的注射吸毒者中艾滋病毒血清阳性率的高和低。潜在的受试者将从探访SEP的人员中随机选择。将获得有关人口统计特征、吸毒模式以及注射和性危险行为的数据。音频-计算机辅助的结构化访谈是一种增加受访者隐私的创新技术，将用于收集SEP参与者的数据。我们的初步研究(授予R01 DA 09536)表明，这种方法可以大大减少对艾滋病毒危险行为的漏报。这项拟议的研究将是美国第一次对注射器交换规划状况进行全国性评估，并将使用创新的数据收集方法来更完整地报告SEP参与者的艾滋病毒风险行为。研究中获得的信息应该对美国的艾滋病毒预防规划以及理解已经参与预防计划的人中持续的危险行为都是有用的。

Many if not most of the new HIV infections in the US are occurring among intravenous drug users (IDUs) and their sexual partners. Three types of programs have been shown to be effective in reducing HIV risk behaviors in this population: community outreach, drug abuse treatment, and syringe exchange programs (SEPs). National assessments of community outreach and drug abuse treatment programs have been conducted, but notably absent is a similar assessment of the state of SEPs in the US. The proposed research seeks to fill that gap. The proposed research addresses the following specific aims: (1) a description of the organizational characteristics of SEPs operating in the U.S. with a description of change in these programs over time; (2) an assessment of the demographic characteristics and risk behaviors of SEP participants; (3) the identification of individual-level factors associated with continued or persistent risk behaviors; (4) the identification of SEP organizational characteristics associated with risk among participants; (5) an examination of the relationships between SEP characteristics and change in risk behaviors among participants; and (6) an estimation of HIV incidence among participants in large SEPs. To achieve these aims, we will conduct annual telephone surveys of the directors of currently operating SEP in the US. This will provide current information on SEP implementation, organizational characteristics of SEPs, and services offered at SEPs. We will also conduct a stratified random sample of 25,920 interviews of participants in 6 large and 18 medium SEPs. The sampled programs will represent approximately half of all SE activity in the US. The sampling will be constricted to provide geographic representation and high versus low HIV seroprevalence rates among the IDUs served by the programs. Potential subjects will be randomly selected from persons visiting the SEPs. Data on demographic characteristics, drug use patterns and injection and sexual risk behaviors will be obtained. Audio-computer assisted structured interviewing, an innovative technique for increasing respondent privacy, will be used for SEP participant data collection. Our pilot study (grant R01 DA 09536) showed that this method can substantially reduce underreporting of HIV risk behavior. The proposed research will be the first national assessment of the state of syringe exchange programming in the US, and will use innovative data collection method to provide more complete reporting of HIV risk behaviors among SEP participants. The information obtained in the research should be useful for both HIV prevention planning in the US as well as understanding persistent risk behavior among persons already participating in prevention programs.