HIV Disparities among Drug Users: Neighborhoods, Neurocognition and Sex Behavior

描述（由申请人提供）：此R03申请建议进行二次数据分析，以开发统计模型，解释非洲裔美国人和白人药物使用者在艾滋病毒/艾滋病方面的差异。在拟议的研究中，我们将采用先进的统计分析（潜在变量混合模型）来考虑邻里因素（毒品逮捕率和贫困）、物质使用模式和神经认知功能对性风险伙伴关系的单独和协同影响，进而影响艾滋病毒/艾滋病。首先，我们将评估不同社区层面因素（隔离、毒品市场、贫困）与性伙伴关系和艾滋病毒/艾滋病之间可能存在的特异性关系。该研究的目的2是建立社区特征、物质使用模式、监禁和神经认知功能对性风险伙伴关系的影响模型，并估计18个月期间的患病率和发病率。第三个目标是估计性伙伴关系与感染艾滋病毒之间的关联程度。考虑了影响修改的可能性，重点是种族和性别。如果成功，该项目将通过以下方式改善预防科学：(1)增加对吸毒者之间性风险伙伴关系的了解，以及他们在种族和性别之间的差异；(2)在试图理解艾滋病毒的种族差异时，通过强调毒品（例如吸毒被捕率）对性伙伴关系的背景影响的重要性，为考虑传统社会经济地位指标之外的因素提供支持；(3)明确可能介导/调节邻里关系、物质使用和性风险伙伴关系之间关系的潜在神经认知过程。这项研究是旨在解释非裔美国人的种族差异和预防艾滋病毒/艾滋病的一系列创新研究中的第一项。

DESCRIPTION (provided by applicant): This R03 application proposes to conduct secondary data analysis to develop statistical models that explain disparities in HIV/AIDS found among African American and white substance users. In the proposed study, we will employ advance statistical analyses (latent variable mixture models) to consider the separate and synergistic influence of neighborhood factors (drug arrest rates and poverty), substance use patterns and neurocognitive functioning on sexual risk partnerships and, in turn, HIV/AIDS. First, we will evaluate the possible specificity in relationships between distinct neighborhood level factors (segregation, drug markets, poverty) and sexual partnerships and HIV/AIDS. Aim 2 of the study is to model the influence of neighborhood characteristics, substance use patterns, incarceration and neurocognitve functioning on sexual risk partnerships and estimate prevalence and incidence over an18-month period. The third aim is to estimate the magnitude of the association between sexual partnerships and being HIV-infected. The possibility of effect modification is considered with a focus on race and gender. If successful, this project should improve prevention science by: (1) increasing understanding of sexual risk partnerships among drug users and how they vary across race and gender; (2) providing support for considering factors beyond traditional SES indicators when attempting to understand racial disparities in HIV by highlighting the importance of contextual influences of drugs (e.g., rate of drug arrests) on sexual partnerships; and (3) specifying potential neurocognitive processes that might mediate/moderate the relationship between neighborhood, substance use and sexual risk partnerships. This study is the first in a series of innovative studies designed to explain racial disparities and prevent HIV/AIDS among African Americans. PUBLIC HEALTH RELEVANCE: The intersection between substance use and HIV is a major concern as core and peripheral members of drug networks represent a significant portion of HIV/AIDS cases. Although all persons involved in drug networks are at increased risk for HIV, African Americans tend to be disproportionately affected. Because interventions focused solely on the individual have had limited success in slowing the spread of HIV among African Americans, it is important to elucidate the influence and model the pathways through which social and interpersonal factors influence HIV acquisition.