Spatial Variations in IDU HIV Risk: Relationship to Structural Interventions

描述（由申请人提供）：非法吸毒者从事与毒品有关的艾滋病毒风险行为或遭受与毒品有关的不良健康后果的可能性在社区之间差异很大。虽然一个新兴的研究方向已经调查了特定的社区水平特征（例如，尽管存在破旧住房和社会混乱的情况决定了这些药物相关行为和健康结果的邻里水平变化，但尚未有研究研究表明注射器获取（SA）计划或药物相关刑事司法（D-RCJ）活动是否有助于非法药物使用者（包括注射药物使用者（IDUs））中药物相关行为和健康结果的邻里水平变化。这种缺失令人震惊：（1）SA方案和D-RCJ活动影响与药物有关的健康行为、结果和服务使用的模式;（2）SA方案和D-RCJ活动是基于地点的结构性干预：它们在社区之间分布不均匀，并塑造了注射吸毒者使用药物的当地环境;（3）D-RCJ活动（可能还有SA项目）对不同种族/民族的IDUs的HIV危险行为和卫生服务利用产生不同的影响。解释与毒品有关的艾滋病毒风险和卫生服务使用的种族/民族差异是NIDA的优先事项。然而，目前的SA方案和D-RCJ活动的措施，排除了研究这些干预措施是否形成与毒品有关的艾滋病毒风险行为，健康结果和注射吸毒者之间的服务使用的地理变异。拟议的探索性研究将通过分析现有数据实现3个目标：（1a）构建SA计划和D-RCJ活动的新措施，作为基于场所的，结构性的和多维的干预措施;（1b）应用这些措施来描述纽约市42个卫生区SA计划和D-RCJ活动随时间（1995-2006）的变化。通过应用空间分析方法，我们将计算，为每个纽约市卫生区和年，空间获得注射器和SA程序（整体和程序类型）;和强度与毒品有关的逮捕，监禁，和警察监视。(2)使用多层次的方法来探讨是否在这些措施的差异在卫生地区和时间之间的差异与注射吸毒者之间的毒品相关的艾滋病毒的危险行为和卫生服务的使用跨地区和时间。(3)探索这些地区一级措施的差异是否会在注射吸毒者的种族/族裔群体内部和之间造成与毒品有关的艾滋病毒风险行为和服务使用的差异。拟议的项目将为未来调查SA计划和D-RCJ活动在广泛的健康行为（例如，艾滋病毒性风险），结果（例如，艾滋病毒传播）和服务使用（例如，在多个城市的注射吸毒者群体中，基于这些措施的研究可能会提供重要的洞察如何修改SA程序和D-RCJ活动，以减少吸毒者，他们的性伴侣和邻居之间的发病率和死亡率。与毒品有关的艾滋病毒风险行为和与毒品有关的不良健康结果的发生率在城市的各个社区都有所不同。目前还没有研究探讨注射器获取（SA）计划或与毒品有关的刑事司法（D-RCJ）活动是否会影响这种邻里水平的变化。拟议的项目将构建SA计划和D-RCJ活动的措施，使我们能够探索这些计划和活动是否在城市中与药物相关的关键健康行为，结果和服务使用方面产生邻里水平的变化，并将根据经验测试在一个美国城市（纽约市）中SA程序和D-RCJ活动的变化是否与（1）毒品注射者的毒品的社区水平变化相关，相关的HIV危险行为和卫生服务使用;（2）这些结果的种族/民族差异。SA计划和D-RCJ活动的项目创建的测量可以应用于其他城市，并且可以用于分析注射者之间广泛的健康行为，结果和服务使用的社区水平变化（例如，性风险行为、HIV或HCV传播、药物治疗进入）。基于这些措施的研究可能会提供重要的洞察如何修改SA程序和D-RCJ活动，以减少吸毒者，他们的性伴侣和邻居之间的发病率和死亡率。考虑到SA计划对当地生活质量的不利影响，项目措施也可以用来实证检验SA计划在社区中的存在与当地犯罪率和其他不良社会后果之间的关系。

DESCRIPTION (provided by applicant): The likelihood that illicit drug users will engage in drug-related HIV risk behaviors or suffer adverse drug-related health outcomes varies considerably across neighborhoods. While an emerging line of research has investigated whether particular neighborhood-level characteristics (e.g., presence of dilapidated housing and social disorder) determines neighborhood-level variation in these drug-related behaviors and health outcomes, no research has yet studied whether syringe access (SA) programs or drug-related criminal justice (D-RCJ) activities contribute to neighborhood-level variations in drug-related behaviors and health outcomes among illicit drug users, including injection drug users (IDUs). This absence is striking: (1) SA programs and D-RCJ activities affect patterns of drug-related health behaviors, outcomes, and service use; (2) SA programs and D- RCJ activities are place-based, structural interventions: they are unevenly distributed across neighborhoods and shape the local context in which IDUs use drugs; and (3) D-RCJ activities (and possibly SA programs) exert different impacts on drug-related HIV risk behaviors and health service use among IDUs of different racial/ethnic groups. Explaining racial/ethnic variations in drug-related HIV risk and health service use is a NIDA priority. Current measures of SA programs and D-RCJ activities, however, preclude studying whether these interventions shape geographic variation in drug-related HIV risk behaviors, health outcomes and service use among IDUs. The proposed exploratory study will achieve 3 aims by analyzing existing data: to (1a) Construct new measures of SA programs and D-RCJ activities as place-based, structural, and multidimensional interventions; and (1b) Apply these measures to describe variations in SA programs and D- RCJ activities over time (1995-2006) across NYC's 42 health districts. By applying spatial analysis methods we will calculate, for each NYC health district and year, spatial access to syringes and to SA programs (overall and by program type); and intensity of drug-related arrest, incarceration, and police surveillance. (2) Use multilevel methods to explore whether variations in these measures across health districts and time are related to variations among IDUs in drug-related HIV risk behaviors and health service use across districts and time. (3) Explore if variations in these district-level measures create variations in drug-related HIV risk behaviors and service use, both within and between racial/ethnic groups of IDUs. The proposed project will lay the foundations for future investigations of the ways that SA programs and D-RCJ activities shape neighborhood- level variations in a wide range of health behaviors (e.g., HIV sexual risk), outcomes (e.g., HIV transmission), and service use (e.g., drug treatment entry) among IDU populations in multiple cities. Research based on these measures may provide important insight into how to modify SA programs and D-RCJ activities so as to reduce morbidity and mortality among drug users, their sex partners, and neighbors. Public Health Relevance Statement Rates of drug-related HIV risk behaviors and adverse drug-related health outcomes vary across neighborhoods in a city. No research has yet explored whether syringe access (SA) programs or drug-related criminal justice (D-RCJ) activities affect this neighborhood-level variation. The proposed project will construct measures of SA programs and D-RCJ activities that will allow us to explore whether these programs and activities create neighborhood-level variation in key drug-related health behaviors, outcomes, and service use in a city, and will empirically test whether changes in SA programs and D-RCJ activities in one US city (NYC) are associated with (1) neighborhood-level variation in drug injectors' drug-related HIV risk behaviors and health service use and (2) racial/ethnic variations in these outcomes. Project-created measures of SA programs and D-RCJ activities can be applied to other cities, and can be used to analyze neighborhood-level variations in a wide range of health behaviors, outcomes, and service use among injectors (e.g., sexual risk behaviors, HIV or HCV transmission, drug treatment entry). Research based on these measures may provide important insight into how to modify SA programs and D-RCJ activities so as to reduce morbidity and mortality among drug users, their sex partners, and neighbors. Given concerns that SA programs adversely affect local quality of life, project measures can also be used to empirically test the relationship between SA program presence in a neighborhood and local crime rates and other adverse social outcomes.