Developing measures to study how structural interventions may affect HIV risk

描述（由申请人提供）：尽管采取了所有预防措施，美国每年仍有56，000例新的艾滋病毒感染病例。这一领域的领导人呼吁采取“结构性”或“社会”干预措施，以影响风险环境、网络和社会规范，这些因素会影响风险行为和/或未感染艾滋病毒者与感染者发生性关系或注射毒品的可能性。制定行之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取得部分成功（如果是这样的话）。为了从这些试验中学习，必须能够测量将干预目标（通常是法律，组织特征或社会计划，如住房供应）与行为，风险环境或风险网络的变化以及STI或HIV发病率联系起来的途径。该项目旨在制定可靠和有效的措施，衡量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。这些途径将包括A。个人感知的直接社会环境; B.个人的生活是如何构成的，可能会影响他们对环境变化的反应;以及c.个人如何对环境中其他人的规范性影响做出反应（以及他们因此而发展的规范）。该项目的具体目标是制定这些措施，以评估其可靠性和并发标准的有效性，然后描述这些变量之间的分布合理的注射吸毒者，高风险异性恋者和男性之间发生性关系的纽约市（美国艾滋病毒流行的震中）的代表性样本。我们将使用民族志的方法来开发的措施，然后通过调查290名注射吸毒者，290名高风险的异性恋者，和290名男性与男性发生性关系，以描述他们的心理测量特性和他们的人口分布。我们将向美国和全球的研究人员提供这些措施，以便他们可以使用它们--也许以适合其他国家的修改后的文化形式--来制定和评估结构性干预措施;并且，在一个联合研究领域--了解战争或大规模社会经济变化等大规模社会变化有时会导致艾滋病毒流行，有时不会。

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.