High Risk Crack Use Settings and HIV in El Salvador

描述（由申请人提供）：这个为期4年的项目的目的是“萨尔瓦多的高危可卡因使用环境和艾滋病毒”，目的是对圣萨尔瓦多大都市区目标社区的可卡因使用和性冒险的社会背景进行形成性研究。该研究的目的如下：1)识别和描述圣萨尔瓦多都市地区三种低收入社区内部和之间的结构差异，这些差异影响了可卡因使用和艾滋病毒风险的社会背景；2)记录三种类型社区中吸毒场所、吸毒者个人风险网络和药物分销系统的变异性范围；3)研究药物流通系统、药物使用环境和吸毒者网络与HIV风险之间的关系；4)估计圣萨尔瓦多大都市区快客吸毒者的艾滋病毒感染率。这项研究的结果将用于与社区伙伴合作开发和探索艾滋病预防干预的可行性和可接受性，这将解决社区结构因素和可卡因使用和危险性行为的微观社会背景。该项目的另一个目标是提高萨尔瓦多合作研究人员的能力，以便在进行研究和干预发展时综合质量、调查和网络数据。本研究将采用定性与定量相结合的研究方法。在研究的第一阶段，我们将在9个社区（每种类型3个）进行形成性人种学研究（社区观察、焦点小组和深度访谈），以检查社区之间的结构差异，这些差异可能导致可卡因消费和危险性行为发生的地点、吸毒者在药物分销系统中的角色和吸毒者网络的差异。我们将利用形成性人种学研究开发和试点一种调查工具，以衡量社区的宏观社会特征、吸毒的微观社会背景以及个人层面的吸毒和艾滋病毒风险行为。在项目的第二阶段，我们将对540名快克吸烟者进行调查，以探索三种社区类型内部和之间吸毒微观社会环境和艾滋病毒风险的变异性，并测试吸毒微观社会环境与艾滋病毒风险之间的关系。此外，我们将在6个月时对所有调查参与者进行简短的随访访谈，以评估在萨尔瓦多背景下跟踪和留住参与者进行随访访谈的不同方法的有效性，并证明纵向研究设计的可行性，这对于严格评估艾滋病毒预防干预措施是必要的。在项目的最后阶段，我们将向九个社区的主要利益相关者展示研究结果，以制定多层次的艾滋病毒预防干预措施。然后，我们将通过与社区领袖和破解用户的焦点小组访谈来探索干预的可接受性和可行性。

DESCRIPTION (provided by applicant): The purpose of this 4-year project entitled "High Risk Crack Use Settings and HIV in El Salvador" is to conduct formative research on the social context of crack use and sexual risk-taking in targeted communities in the San Salvador metropolitan area. The study has the following aims: 1) To identify and describe structural differences within and across three types of low-income communities in the San Salvador metropolitan area that affect the social context of crack use and HIV risk; 2) To document the range of variability in drug use sites, drug users' personal risk networks, and drug distribution systems across the three types of community; 3) To examine the relationship between drug distribution systems, drug use settings and drug user networks and HIV risk; 4) To estimate HIV prevalence among crack users in the San Salvador metropolitan area. Results from this study will be used to develop and explore the feasibility and acceptability of an HIV prevention intervention in collaboration with community partners that will address both community structural factors and the micro-social context of crack use and risky sex. An additional aim of the project is to increase the capacity of collaborating Salvadoran researchers to integrate qualitative, survey and network data in the conduct of research and intervention development. The proposed study will combine qualitative and quantitative research methods. In the first phase of the study we will conduct formative ethnographic research (community observations, focus groups and in-depth interviews) in nine communities (three of each type) in order to examine structural differences among the communities that may result in differences in the sites where crack is consumed and risky sex occurs, drug user roles in the drug distribution system, and drug user networks. We will use the formative ethnographic research to develop and pilot a survey instrument to measure macro-social characteristics of communities, the micro-social context of drug use, and individual-level drug use and HIV risky behaviors. In the second phase of the project we will conduct a survey with 540 crack smokers to explore variability in the micro-social context of drug use and HIV risk within and among the three community types, and to test the relationship between micro-social context of drug use and HIV risk. Additionally, we will conduct an abbreviated follow-up interview at 6 months with all survey participants in order to assess the effectiveness of different methods for tracking and retaining participants for follow-up interviews in the Salvadoran context, and demonstrate the feasibility of longitudinal research designs necessary for the rigorous evaluation of an HIV prevention intervention. In the final phase of the project, we will present the findings of the study to key stakeholders in the nine communities in order to develop a multi-level HIV prevention intervention. We will then explore the acceptability and feasibility of the intervention through focus group interviews with community leaders and crack users.