Developing measures to study how structural interventions may affect HIV risk

描述（由申请人提供）：尽管采取了各种预防措施，但美国每年仍有56,000例新的艾滋病毒感染。该领域的领导人呼吁采取“结构性”或“社会”干预措施，影响影响危险行为和（或）未感染艾滋病毒者与感染者发生性行为或注射毒品的可能性的风险环境、网络和社会规范。制定有效的结构性干预措施将是困难的，需要进行大量的研究。与艾滋病毒行为干预、疫苗试验和杀微生物剂研究的情况一样，最初的结构性干预努力可能只会取得部分成功（如果成功的话）。为了从这些试验中学习，必须能够衡量将干预目标（通常是法律、组织特征或住房供应等社会项目）与行为、风险环境或风险网络的变化、进而与性传播感染或艾滋病毒发病率联系起来的途径。该项目旨在开发可靠和有效的措施，以确定上游变化或干预措施与感染的直接原因之间的重要中间途径。这些途径包括a.个体感知到的直接社会环境；B.个人的生活结构如何影响他们对环境变化的反应；c.个人如何对环境中他人的规范影响做出反应（以及他们由此形成的规范）。该项目的具体目标是制定这些措施；评估其信度和并发效度；然后描述这些变量在纽约市（美国艾滋病毒流行的中心）注射吸毒者、高危异性恋者和男男性行为者的合理代表性样本中的分布。我们将通过使用人种学方法来制定措施来做到这一点；然后通过调查290名注射吸毒者，290名高危异性恋者，和290名男男性行为者来描述他们的心理特征和人口分布。我们将把这些措施提供给美国和全球的研究人员，这样他们就可以使用它们——也许以其他国家改良的具有文化竞争力的形式——来开发和评估结构性干预措施；在一个相关的研究领域，了解大规模的社会变化，如战争或大规模的社会经济变化，有时会，有时不会导致艾滋病毒的流行。

DESCRIPTION (provided by applicant): In spite of all prevention efforts, 56,000 new HIV infections take place in the USA each year. Leaders in the field are calling for "structural" or "social" interventions that affect the risk environments, networks and social norms that influence risk behaviors and/or the probability that an HIV uninfected person will engage in sex or drug injection with an infected person. Developing structural interventions that work will be difficult and will require considerable research. As has been the case with HIV behavioral interventions, vaccine trials and microbicide research, initial structural intervention efforts are likely to meet only partial success (if that). In order to learn from these trials, it is essential to be able to measure the pathways that connect the target of the intervention-typically, a law, an organizational characteristic, or a social program such as housing provision- to changes in behaviors, risk environments or risk networks and then to STI or HIV incidence. This project aims to develop reliable and valid measures of important intermediate pathways between upstream changes or interventions and the immediate causes of infection. These pathways will include a. individuals' perceived immediate social environments; b. how individuals' lives are structured in ways that might affect how they react to changes in their environments; and c. how individuals react to normative influence from others in their environments (and the norms they develop as a result). The specific aims of the project are to develop these measures; to assess their reliability and concurrent criterion validity; and then to describe the distributions of these variables among reasonably representative samples of injection drug users, high-risk heterosexuals, and men who have sex with men in New York City (the epicenter of the US HIV epidemic). We will do this by using ethnographic approaches to develop the measures; and then by surveying 290 injection drug users, 290 high-risk heterosexuals, and 290 men who have sex with men to describe their psychometric properties and their population distributions. We will make these measures available to researchers in the USA and globally so they can use them - perhaps in modified culturally competent form for other countries - to develop and evaluate structural interventions; and, in an allied research area - to understand how large-scale social changes like wars or large-scale socioeconomic changes sometimes do and sometimes do not lead to HIV epidemics.