Risk Factors for AIDS Among Intravenous Drug Users

产品描述：风险因素项目研究了从1978年（使用储存的血清）至今纽约市注射毒品使用者中艾滋病毒的大规模流行。1981年发现艾滋病时，HIV在纽约市的IDU中迅速传播，达到50%的患病率，导致该市IDU中有超过50，000例艾滋病病例，几乎占美国所有艾滋病病例的10%。 在1990年代初，注射吸毒者的艾滋病毒预防方案得到了极大的扩展，纽约市已成为注射吸毒者艾滋病毒预防方面最重要的成功案例之一。 自1990年代初以来，注射吸毒者中的艾滋病毒发病率已从5/100人年下降到1-2/ 100人年，流行率从50%下降到15%以下（这是自1978-79年以来的最低水平）。 在目前的预防成功事例中，仍有一些非常重要的问题需要回答：（1）在流行病情况稳定之前，流行率和发病率的下降将持续多久？ (2)目前，种族/族裔群体之间的流行率存在很大差异-黑人为25%，白人为5%，西班牙裔为8%。 预防对所有种族/族裔群体都是成功的，还是目前的差异会无限期地持续下去？ (3)既然与注射有关的艾滋病毒传播已经大大减少，那么性传播将在多大程度上推动艾滋病毒的持续感染？以及（4）在减少艾滋病毒方面取得的成功是否也会导致在纽约市注射吸毒者中成功减少丙型肝炎？ 我们将通过以下方式解决这些问题：（a）继续对危险行为、社会网络因素、预防服务的利用、艾滋病毒流行率和艾滋病毒发病率进行大样本横断面调查（STAHRS测试）;（B）艾滋病毒和性传播感染在注射吸毒者和非注射吸毒者中传播的数学模型;（c）探索性测试纽约市不同种族群体中艾滋病毒株的遗传差异;（d）大样本HCV流行率调查，以及（e）我们的数据与纽约市对注射吸毒者和非注射吸毒者进行的其他研究的定量研究综合。拟议的研究将提供具有重大科学意义和公共卫生重要性的信息，这些信息涉及预防计划控制高HIV和HCV血清流行率流行病的能力，解释HIV感染的种族差异，并检查IDU和NIDU中HIV的性传播。

Description: The Risk Factors project has studied the very large HIV epidemic among injecting drug users (IDUs) in New York City from 1978 (using stored sera) to the present. HIV spread rapidly among lDUs in NYC reaching 50% prevalence by the time AIDS was discovered in 1981 and leading to over 50,000 cases of AIDS among lDUs in the city, almost 10% of all AIDS cases in the US. In the early 1990s, HIV prevention programs for IDUs were greatly expanded, and NYC has become one of the most important success stories in HIV prevention for IDUs. Since the early 1990s, HIV incidence among lDUs has declined from 5/100 person-years (py) to 1-2/ 100 py, and prevalence has declined from 50% to under 15% (a level not seen since 1978-79). There are still very important questions to be answered in this current prevention success story: (1) How far will declines in prevalence and incidence continue before a stable endemic situation develops? (2) There are currently substantial differences in prevalence among racial/ethnic groups--25% among Blacks vs. 5% among Whites, and 8% among Hispanics. Will prevention be successful for all racial/ethnic groups, or will the current differences persist indefinitely? (3) Now that injection-related HlV transmission has been greatly reduced, to what extent will continuing HIV infection be driven by sexual transmission? and (4) Will the success in reducing HIV also lead to success in reducing hepatitis C among lDUs in NYC? We will address these questions through: (a) continuation of our large-sample cross-sectional survey of risk behavior, social network factors, utilization of prevention services, HIV prevalence and HIV incidence (STAHRS testing); (b) mathematical modeling of HIV and STI transmission among lDUs and NIDUs; (c) exploratory testing of genetic differences of HIV strains among different racial ethnic groups in NYC; (d) large-sample HCV prevalence surveys, and (e) quantitative research syntheses of our data with other studies conducted on IDUs and NlDUs in NYC. The proposed research will provide information of great scientific interest and public health importance regarding the ability of prevention programs to control high HIV and HCV sero-prevalence epidemics, explaining racial ethnic differences in HIV infection, and examining sexual transmission of HIV among both lDUs and NIDUs.