Community Vulnerability and Responses to IDU-Related HIV

描述(由申请人提供)：在这项竞争性的继续研究中，我们将对96个大城市地区进行一项纵向研究(1993-2007)，以研究注射吸毒者和注射者中艾滋病毒流行率变化的趋势和预测因素，以及相关的预防计划。在这个项目的第一阶段，我们开发了估计注射吸毒人口密度和大都市地区艾滋病毒流行率的方法。我们显示，1990年代期间，包括巴尔的摩和盐湖城在内的许多地区的人均注射毒品使用量有所增加。在巴尔的摩和其他一些地区，注射吸毒者的艾滋病毒流行率有所上升。在许多大都市地区，注射吸毒者的吸毒率和艾滋病毒感染率有所下降。地方艾滋病毒预防方案到达注射吸毒者的程度也有很大差异：3个大都市地区为20%或更多的注射器提供治疗，而13个地区达到5%以下。艾滋病毒咨询和检测率也有很大差异。在横断面分析中，我们发现地方政府的预算决定、社会和经济因素以及药物滥用干预措施与人均注射吸毒者、注射吸毒者中艾滋病毒感染率以及注射吸毒者中预防艾滋病毒的各种计划的存在和规模有关。我们将在现有数据的基础上，为这96个大都市地区建立一个数据库，其中包含1993-2007年间人均吸毒者的年度估计数；吸毒者中艾滋病毒的流行率、艾滋病发病率和死亡率；计划的可获得性和规模；社会经济状况和政府预算拨款。我们将(1)描述预防方案和流行病学随时间变化的模式。我们将使用纵向分析方法来研究(2)不断变化的社会经济条件、流行病学需求、预算限制和选择以及政策选择如何与随后的艾滋病毒预防规划相关；(3)所有这些变量如何与(A)人均吸毒者、(B)吸毒者中艾滋病毒流行率和艾滋病、(C)针对吸毒者的药物滥用治疗和其他方案以及(D)适当指标中的种族/民族差异的变化相关。我们将利用这些分析来形成对影响大都市地区艾滋病毒/艾滋病流行、人均吸毒率和预防计划的力量的良好理论性的科学理解。由此产生的科学知识库可以帮助制定方案和政策，以避免流行病，并在必要时对其进行控制。

DESCRIPTION (provided by applicant): In this competing continuation, we will conduct a longitudinal study (1993-2007) of 96 large metropolitan areas to study trends and predictors of changes in the population prevalence of drug injectors, HIV) prevalence among injectors, and related prevention programs. In stage one of this project, we developed ways to estimate the population density of injection drug use and HIV prevalence rates in metropolitan areas. We showed that per capita injection drug use increased during the 1990s in many localities, including Baltimore and Salt Lake City. HIV prevalence rates among drug injectors increased in Baltimore and some other areas. In many metropolitan areas, drug injection and HIV rates among injectors declined. The extent to which local HIV prevention programs reached drug injectors also varied widely: 3 metropolitan areas provided treatment to 20% or more of their injectors, while 13 areas reached less than 5%. HIV counseling and testing rates also varied widely. In cross-sectional analyses, we showed that local government budgetary decisions, social and economic factors, and drug abuse interventions were related to injection drug users per capita, HIV revalence among drug injectors, and the presence and size of various programs to prevent HIV among drug injectors. We will build upon our existing data and construct a database for these 96 metropolitan areas containing annual estimates from 1993 - 2007 of drug injectors per capita; HIV prevalence, incident AIDS cases and AIDS mortality among drug injectors; program availability and size; socioeconomic conditions, and government budgetary allocations. We will (1) describe patterns of change over time in prevention programs and epidemiology. We will use longitudinal analysis methods to study (2) how changing socioeconomic conditions, epidemiologic need, budgetary constraints and choices, and policy choices are related to subsequent HIV prevention programming; and (3) how all these variables are related to later changes in (a) drug injectors per capita, (b) HIV prevalence and AIDS among drug injectors, (c) drug abuse treatment and other programs for drug injectors, and (d) racial/ethnic disparities in appropriate indicators. We will use these analyses to develop a well-theorized scientific understanding of forces that shape metropolitan area HIV/AIDS epidemics, rates of drug injectors per capita, and prevention programs. The resulting scientific knowledge base can help develop programs and policies so as to avoid epidemics and, if needed, control them.