The HIV Risk Behavior and the Urban Environment

描述（由申请人提供）：拟议的是一项多层次研究，以确定城市环境特征与艾滋病毒感染的性和药物使用风险因素之间的关联。虽然目前有几个多站点的干预研究，旨在尽量减少个人的高风险性行为和吸毒行为，令人惊讶的是，很少有系统的研究探讨了城市环境，艾滋病毒的风险行为，疾病发病率（性传播疾病和艾滋病毒）的功能之间的关系，同时控制相关的个人水平的协变量。本研究将考察城市社会环境特征的独立和互动效应（例如，收入分配，邻里劣势，种族隔离）和物理环境（例如，人口密度、公共交通、建筑环境），因为它们与艾滋病毒感染的性和吸毒风险因素以及艾滋病毒和性传播疾病流行率有关。为了实现研究目标，我们将在四年的时间里从纽约市的24个社区招募2,000人（包括目前的吸毒者、过去的吸毒者和从未吸毒的人）。我们将使用聚类分析、民族志制图和社区咨询来定义社区。将使用一些街头外联技术招募参与者。个人风险行为和潜在的调解人和主持人将通过面对面的访谈进行评估。城市环境的特征将通过人种学评估和利用可公开获得的档案信息（例如，纽约市住房和空置调查，市长管理报告）。分层多变量模型将被用来确定城市环境的特点和个人的风险行为，艾滋病毒和性病之间的关系。确定城市环境中塑造风险行为的关键特征可以指导结构性干预，提高个人行为干预的效率，并确定可能表明人口易受艾滋病毒快速传播影响的城市社区特征。

DESCRIPTION (provided by applicant): Proposed is a multi-level study to determine the association between features of the urban environment and sexual and drug use risk factors for HIV infection. Although there are at present several multi-site intervention studies that aim to minimize individual high risk sex and drug-use behavior, surprisingly little systematic research has explored the relation between features of the urban environment, HIV risk behavior, and disease morbidity (sexually transmitted diseases and HIV) while controlling for relevant individual-level covariates. This study will examine the independent and interactive effect of features of the urban social environment (e.g., income distribution, neighborhood disadvantage, racial segregation) and the physical environment (e.g., population density, public transportation, built environment) as they relate to sexual and drug use risk factors for HIV infection and to HIV and STD prevalence. To address the study aims, we will recruit 2,000 persons (including current drug users, past drug users, and never drug users) from twenty-four New York City neighborhoods over a four year period. We will define neighborhoods using cluster analysis, ethnographic mapping, and community consultation. Participants will be recruited using a number of street outreach techniques. Individual risk behaviors and potential mediators and moderators will be assessed through in-person interviews. Features of the urban environment will be assessed from the ethnographic assessments and using publicly available archival information (e.g., New York City Housing and Vacancy Survey, Mayor's Management Report). Hierarchical multivariate modeling will be used to determine the relations between features of the urban environment and individual risk behavior, HIV, and STDs. Identification of the key features of the urban environment that shape risk behavior can guide structural interventions, increase the efficiency of individual-level behavioral interventions, and identify features of urban neighborhoods that could suggest population vulnerability to rapid transmission of HIV.