HIV RISK BEHAVIORS AMONG URBAN NOMAD DRUG INJECTORS

艾滋病毒、乙肝和丙型肝炎在注射吸毒者中的全球传播既表明他们进行了大量的旅行，也表明需要对他们的旅行模式进行研究。以前的研究表明，注射吸毒者在区域、国家和国际上旅行，但没有充分描述旅行模式，也没有充分描述影响注射吸毒者旅行时艾滋病毒风险行为的因素。通过我们在纽约市对注射吸毒者进行的街头研究，我们对一大群流动性很高的年轻注射吸毒者有了相当的熟悉，他们自称是“城市游牧者”，他们经常在美国各地广泛旅行。这些城市游牧者经常无家可归，但在概念和行为上都与“当地无家可归”的注射吸毒者截然不同，后者在地理上没有流动性。具体目标包括方法目标和实质性目标：(目标1)分析描述大样本(n=800)“城市游牧民”年轻注射吸毒者，包括他们的人口结构、吸毒史、旅行史、艾滋病毒危险行为和血清状况。确定与(A)艾滋病毒危险行为和(B)城际旅行频率相关的因素。(目标2)查明城市游牧注射吸毒者在旅行期间使用毒品和艾滋病毒危险行为的模式，包括“人员旅行”次数(一个人到另一个大都市地区的旅行)，艾滋病毒危险行为发生和没有发生的人员旅行的地理分布，以及区分有和没有艾滋病毒危险行为的人员旅行的因素。目标1和目标2将通过采访在纽约市招募的600名城市游牧民吸毒者和在全国各地合作研究地点招募的200名城市游牧民吸毒者来实现。(目标3)实施和评估长途电话跟踪访谈系统，以收集城市游牧民在旅行中的数据。受试者将紧锣密鼓地准备与研究人员保持电话联系。长途电话面谈将通过转介到当地关于艾滋病毒咨询和检测的研究，通过转介到注射器交换计划，以及通过电子邮件和网站交流来补充。(目的4)在使用这些技术的随访中，确定潜在的损失偏向。估计的偏差然后可以用来调整对持续药物使用和危险行为的估计。目标3和4将通过对在纽约招募的300名受试者进行队列研究来实现。注射吸毒者的吸毒和艾滋病毒危险行为通常被视为局部现象，吸毒行为、危险行为和艾滋病毒流行发生在特定的地理区域内。拟议的研究将为一个互补的视角提供数据和研究技术，该视角看到毒品使用做法和血液传播的病原体在一个松散整合的全国非法药物使用“系统”内扩散。

The global diffusion of HIV, hepatitis B and hepatitis C among injecting drug users (IDUs) shows both that they engage in substantial travel and that research is needed on their travel patterns. Previous research makes it clear that IDUs travel regionally, nationally, and internationally, but has not adequately described travel patterns nor the factors that influence IDUs' HIV risk behavior when they travel. Through our street-based research with IDUs in New York City, we have developed considerable familiarity with a large group of highly mobile, young IDUs, self-defined as "urban nomads", who travel frequently and widely throughout the U.S. These urban nomads are often homeless, but are conceptually and behaviorally distinct from "locally homeless" drug injectors who are not geographically mobile. The specific aims include both methodological and substantive objectives: (Aim 1) Analytically describe a large sample (n = 800) of "urban nomad" young IDUs, including their demographics, drug use histories, travel histories, HIV risk behaviors and serostatus. Identify factors associated with (a) HIV risk behaviors and (b) frequency of intercity travel. (Aim 2) Identify patterns of drug use and HIV risk behavior during travel by urban nomad IDUs, including numbers of "person-trips" (a trip by a person to another metropolitan area), the geographic distribution of person- trips where HIV risk behaviors do and do not occur, and factors that differentiate person-trips with and without HIV risk behavior. Aims 1 and 2 will be achieved through interviews with 600 urban nomad IDUs recruited in New York City and 200 urban nomad IDUs recruited at collaborating research sites across the country. (Aim 3) Implement and assess a long-distance telephone follow-up interview system for collecting data from urban nomad IDUs in their travels. Subjects will be intensively prepared to maintain telephone contact with researchers. Long-distance telephone interviewing will be supplemented by referrals to local research studies for HIV counseling and testing, by referrals to syringe exchange programs, and by e-mail and web site communication. (Aim 4) Determine potential biases in loss to follow-up in using these techniques. Estimated biases can then be used to adjust estimates of continuing drug use and risk behaviors. Aims 3 and 4 will be achieved through a cohort study of 300 subjects recruited in New York. Drug use and HIV risk behavior among IDUs are often viewed as local phenomena, with drug practices, risk behaviors and HIV epidemics occurring within defined geographic areas. The proposed research will provide data and research technologies for a complementary perspective that sees drug use practices and blood-borne pathogens diffusing within a loosely integrated nation-wide "system" of illicit drug use.