Modeling HIV Diffusion through Drug Using Networks

描述(由申请人提供)： 在南方，艾滋病毒在女性、少数民族和与男性发生性行为的男性中的性传播正在增加。此外，在最近的几项研究中，注射吸毒者中艾滋病毒的发病率与性危险行为的相关性比注射危险行为更大。与性传播有关的艾滋病毒发病率的增加可能反映了干预措施在降低注射风险方面的成功，以及这样一个事实，即除了个人动机外，减少性风险往往还受到社会、性别和文化规范的影响。此外，南方的毒品使用模式发生了变化，少数族裔和农村地区的吸毒率很高。拟议的为期5年的多方法纵向研究将确定与艾滋病毒和其他性传播感染在吸毒群体中以及从吸毒者到北卡罗来纳州农村和城市环境中的非吸毒者的性传播有关的因素。该方法将结合人种学观察、个人行为访谈、社会网络分析、生物测试和结构性环境评估。这些数据将为建立农村和城市吸毒者艾滋病毒流行的概念和数学模型提供投入。这种模型可以帮助确定哪些可改变的行为和结构因素对减少艾滋病毒和性传播感染的影响最大，从而帮助制定干预措施。拟议的小组将与州艾滋病毒/艾滋病办公室和北卡罗来纳大学艾滋病研究中心病毒学核心合作进行病毒学测试，以确定最近的艾滋病毒感染情况。这项研究的具体目的如下：1.评估环境(如社区特征、城乡环境和针具使用情况)、社会网络(如密度、规模和稳定性)和个人(如年龄、种族和性别)特征对个人危险行为、艾滋病毒和性传播疾病患病率和发病率的影响。2.查明和描述与城乡环境、社会结构、危险行为、地理位置和环境条件有关的社会网络特征的差异，并将这些差异与网络内和网络之间的艾滋病毒和性传播感染的传播联系起来。3.建立艾滋病毒和性传播感染在网络内、网络之间和网络外传播的概念模型。该模型将以目标1和目标2中的发现为基础，包括生物、个人、网络和环境因素及其与风险行为的相互作用。4.建立一个数学模型，使目标3中的概念模型具有可操作性。该模型将综合目标1至目标3的结果，以便(通过模拟)估计在不同级别(生物、个人、网络和环境)和在级别内的特定点进行干预的影响。

DESCRIPTION (provided by applicant): Sexual transmission of HIV is increasing in the South among women, minorities, and men who have sex with men. Moreover, in several recent studies, HIV incidence among injecting drug users was associated more with sexual risk behaviors than injecting risk behaviors. The increasing incidence of HIV associated with sexual transmission may reflect the success of interventions in reducing injecting risk, and the fact that sexual risk reduction is often influenced by social, gender, and cultural norms in addition to individual motivation. Furthermore, patterns of drug use have shifted in the South, with high rates of crack use among minorities and within rural areas. The proposed 5-year multimethod longitudinal study will identify factors associated with the sexual diffusion of HIV and other sexually transmitted infections (STIs) within drug-using groups and from drug users to non-drug users in rural and urban settings in North Carolina. The approach will combine ethnographic observations, individual behavioral interviews, social network analysis, biological testing, and structural environmental assessments. These data will provide inputs for developing conceptual and mathematical models of HIV epidemics among drug users in rural and urban settings. Such models can aid in intervention development by helping to determine which modifiable behavioral and structural factors would have the greatest impact on reducing HIV and STI transmission. The proposed team will work collaboratively with the State HIV/AIDS office and the University of North Carolina (UNC) Center on AIDS Research Virology Core for virological testing to identify recent HIV infections. The specific aims of the study are as follows: 1. To assess the effects of environmental (e.g., neighborhood characteristics, rural-urban setting, and syringe access), social network (e.g., density, size, and stability), and personal (e.g., age, race, and gender) characteristics on individual risk behavior, prevalence, and incidence of HIV and STIs. 2. To identify and describe differences in social network characteristics associated with urban-rural settings, social structure, risk behaviors, geographic location, and environmental conditions and to link these differences to the spread of HIV and STIs within and between networks. 3. To develop a conceptual model of HIV and STI transmission within, between, and outside the networks. This model will be based on the findings in Aims 1 and 2 and include biological, personal, network, and environmental components and their interaction with risk behavior. 4. To develop a mathematical model that will operationalize the conceptual model in Aim 3. This model will synthesize findings from Aims 1 through 3 in order to estimate (through simulation) the impact of intervening at different levels (biological, individual, network, and environment) and at specific points within levels.