WHERE TO INTERVENE? GEOSPATIAL VARIATION OF HIV TRANSMISSION BEHAVIORS

描述(由申请人提供)：随着治疗的不断进步，艾滋病毒正成为一种更需要管理的慢性病。虽然这特别令人鼓舞，但它增加了艾滋病毒传播的机会，因为感染这种传染病的人活得更长。为艾滋病毒携带者制定的减少新感染的循证干预措施的范围在某种程度上是有限的，而且这些干预措施中很少有将个人生活的环境作为高危行为的决定因素。考虑到很大一部分艾滋病毒携带者所生活的环境因素，个人行为变化似乎难以持续；正如戒烟所发现的那样，当工作场所和家庭禁烟生效时，个人更成功。酒精和非法药物的使用已被证明与艾滋病毒传播和性传播感染(STI)有近端和远端的关系，这是由于无计划和无保护的性行为以及吸毒者之间共用针头或共用管道与开放的伤口有关。酒精使用率较高的社区与酒精销售场所和使用广告牌进行酒精营销的密度较高的社区有关。吸毒的类型和频率以及性传播感染的比率已被证明因社区而异。此外，很少有研究发现低收入社区的艾滋病毒进展更快。性行为被发现在艾滋病毒诊断后风险较低；但性传播感染的发病率仍在上升，这促使需要加强预防工作。艾滋病毒携带者从事高危行为显然仍在继续，需要采取更有效的干预措施来阻止艾滋病毒的传播。个人层面的降低风险努力尚未取得广泛成功。找出影响艾滋病毒携带者高危行为的邻里因素可能有助于制定适当的干预措施。这项研究旨在调查美国4个大都市7家不同艾滋病毒诊所的艾滋病毒携带者中非法药物使用行为、酒精消费和性危险行为的地理分布。这些发现还将揭示以社区为基础的干预措施旨在减少艾滋病毒传播的机会。这项研究被提议作为一个机会，重新调整来自已建立的疾病控制和预防中心(CDC)资助的多地点研究的数据，以了解有效治疗时代艾滋病毒和艾滋病的自然历史。具体地说，本研究旨在：(1)利用个人访谈和地理信息系统，在多个城市(密苏里州圣路易斯、明尼苏达州明尼阿波利斯、科罗拉多州丹佛和里约热内卢普罗维登斯)的700名艾滋病毒感染者中建立危险行为(非法药物和酒精使用、性行为)的多水平模型，以及(2)建立4个大都市地区艾滋病毒感染者高危行为环境的空间模型，该模型可以解释艾滋病毒感染者高危行为的地理差异，并确定可以实施干预的地区。 公共卫生相关性：这项研究旨在评估社区在参与高危行为方面的作用，包括非法药物和酒精使用以及无保护措施的性行为，因为它们有助于艾滋病毒的传播。我们提出了一项研究，代表了美国4个大都市7家诊所从事护理工作的艾滋病毒携带者的样本。美国的预防工作成效有限，每年艾滋病毒病例的发生率保持不变。了解在受感染人群中发生艾滋病毒传播行为的环境背景将增加确定预防艾滋病毒传播的新的适当干预领域的机会。这些发现将影响美国的临床实践和整体艾滋病毒预防工作。

DESCRIPTION (provided by applicant): HIV is becoming more of a chronic disease to manage with continuing treatment advancements. While this is particularly encouraging, it poses increased opportunities for HIV transmission, due to individuals living longer with the infectious disease. The development of evidence-based interventions for populations with HIV to reduce new infections has been somewhat limited in scope, and very few of those interventions have incorporated the environment in which individuals live as a determinant of high-risk behaviors. Individual behavior change seems additionally challenging to sustain considering the environmental factors in which a large proportion of individuals with HIV live; as has been found in smoking cessation, where individuals are more successful when worksite and home smoking bans are in effect. Alcohol and illicit drug use have been shown to be proximally and distally related to HIV transmission and sexually transmitted infections (STI) due to unplanned and unprotected sexual behavior as well as needle sharing or sharing pipes with open sores among drug use partners. Higher rates of alcohol use have been associated in neighborhoods with higher density of alcohol-selling establishments as well as marketing of alcohol using billboards. Types and frequency of drug use and rates of STIs have been shown to vary by neighborhood. Furthermore, there have been few studies that found faster HIV progression occurring in low-income neighborhoods. Sexual behaviors have been found to be less risky after HIV diagnosis; yet STI incidence rates continue, which urges the need for improved prevention efforts. Engagement in high-risk behaviors is clearly continuing among individuals with HIV and more effective interventions are necessary to stop the transmission of HIV. Individual- level risk reduction efforts have not yet been broadly successful. Finding neighborhood factors that influence high risk behaviors among individuals with HIV may help develop appropriate interventions. This study aims to examine the geographic distribution of illicit drug using behaviors, alcohol consumption, and sexual risk behaviors among individuals with HIV in 4 U.S. metropolitan areas across 7 different HIV clinics. These findings will also reveal opportunities for neighborhood-based interventions aimed to reduce HIV transmission. This study is being proposed as an opportunity to repurpose data from the established Centers for Disease Control and Prevention (CDC)-funded multi-site Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy. Specifically, this study aims to: (1) develop a multilevel model of risk behaviors (illicit drug and alcohol use, sexual behaviors) among 700 individuals with HIV in a multi-city (St. Louis, MO; Minneapolis, MN; Denver, CO; and Providence, RI) sample using individual interviews and GIS, and (2) develop a spatial model of high-risk behavior environments among individuals with HIV in the 4 metropolitan areas that can explain geographic differences high-risk behaviors among individuals with HIV and identify areas where interventions could be implemented. PUBLIC HEALTH RELEVANCE: This study aims to assess the role of the neighborhood on engagement in high-risk behaviors, including illicit drug and alcohol use and unprotected sexual behaviors as they contribute to the transmission of HIV. We have proposed a study that represents a sample of individuals with HIV who are engaged in care in 4 U.S. metropolitan areas across 7 clinics. Prevention efforts in the U.S. have had limited effectiveness, with consistent rates of HIV incident cases annually. Understanding the environmental context in which HIV transmission behaviors occur among infected populations will enhance the opportunities to identify new and appropriate areas of intervention to prevent HIV transmission. These findings will impact clinic practices and overall HIV prevention efforts in the U.S.