Initiation of injection drug use and HIV risks among street-involved youth

描述(申请人提供)：本申请的目的是评估甲基苯丙胺和一系列社会、结构和环境因素对街头青少年开始注射毒品、艾滋病毒危险行为和性传播感染(STI)发生率的影响。在全球范围内，估计有多达1亿名流落街头的青年，非法吸毒和相关危害(如传染病)在这一人群中的比例一直在上升。因此，迫切需要数据，以便为旨在解决这一不断增长的人口的卫生需求的干预措施提供信息。特别是，鉴于预防青少年开始注射毒品后出现的危害(如艾滋病毒感染)的挑战，迫切需要数据，以便为防止开始注射毒品的战略提供信息。我们建议在加拿大西部开展这项工作，在那里，甲基苯丙胺使用量的爆炸性增长反映了这种药物在美国西部的使用稳步增长。虽然由于甲基苯丙胺与男男性接触者和成年注射吸毒者艾滋病毒风险行为增加的关系，这些趋势是一个日益令人担忧的问题，但甲基苯丙胺的流行病学及其与性和注射相关的艾滋病毒风险行为的关系仍然没有明确的定义。出于几个原因，加拿大的温哥华非常适合这项拟议的研究。首先，温哥华目前正在经历街头青少年使用甲基苯丙胺的爆炸性增长，过去的经验表明，温哥华的毒品市场趋势经常反映在美国西部的其他城市，而且众所周知，温哥华是几种非法药物和前体化学品的北美入境口岸，这些毒品和前体化学品随后流入美国。因此，这项研究将为了解美国毒品趋势和干预措施提供有价值的数据。温哥华还存在大量明显的街头青年问题和街头非法毒品市场，街头青年卷入非法毒品的风险环境没有得到很好的描述。在此，我们建议对500名14至25岁的街头青少年进行开放式前瞻性队列研究，他们将每半年完成一份标准化问卷并提供生物样本。鉴于当地药物使用和风险环境的特点，以及当地实验室的能力，我们拟议的研究计划提供了一个理想的机会，来研究不断演变的药物使用模式以及一系列社会、结构和环境因素对注射吸毒、性风险行为和性传播感染发生率的影响。这项研究还提供了一个独特的机会，可以创建一个街头非注射青年队列，这将使我们能够与正在进行的成人注射吸毒者研究进行比较。这项研究将共同解决北美街头青年因甲基苯丙胺使用和非法注射毒品的增长而面临的紧迫挑战的几个核心问题，并将能够评估这一人群中艾滋病毒风险行为和性传播感染发病率的一系列个人和背景决定因素。

DESCRIPTION (provided by applicant): The purpose of this application is to evaluate the impacts of methamphetamine and a range of social, structural, and environmental factors on initiation into injection drug use, HIV risk behavior and sexually transmitted infection (STI) incidence among street-involved youth. Globally, it is estimated that there are as many as 100 million street-involved youth, and illicit drug use and related harms (e.g., infectious diseases) have consistently been shown to be elevated among this population. Thus, there is an urgent need for data to inform interventions aimed at addressing the health needs of this growing population. In particular, given the challenges preventing harms (e.g., HIV infection) that occur after youth begin drug injecting, data to inform strategies to prevent initiation into injection drug use are urgently needed. We propose to undertake this work in a western Canadian setting where the explosive growth in methamphetamine use has mirrored a steady growth in the use of this drug in the western United States. While these trends are a source of growing concern due to methamphetamine's relationship with rising HIV risk behavior among men who have sex with men and adult IDU, the epidemiology of methamphetamine use and its relationship to sexual and injection-related HIV risk behavior remain poorly defined. Vancouver, Canada, is ideally suited for the proposed study for several reasons. First, the city is presently experiencing an explosive rise in the use of methamphetamine among street-involved youth, and past experience demonstrates that drug market trends in Vancouver are often reflected in other western US cities, and the city is known to be a North American port of entry for several illicit drugs and precursor chemicals which subsequently flow into the US. Thus, this research will provide valuable data to inform US drug trends and interventions. Vancouver is also home to a large and visible street-youth problem and street-based illicit drug market, and the risk environment in which street youth become involved in illicit drugs has not been well described. Herein, we propose to create an open prospective cohort study of 500 street-involved youth aged 14 to 25 who will complete a standardized questionnaire and provide biological specimens on a semi-annual basis. Given the local drug use and risk environment characteristics, as well as the local laboratory capacity, our proposed research plan offers an ideal opportunity to examine the impact of evolving drug use patterns and a range of social, structural, and environmental factors on the rates of initiation into injection drug use, sexual risk behavior and STI incidence. This research also presents a unique opportunity to create a cohort of street-involved non-injecting youth which will enable comparisons with an ongoing study of adult injection drug users. Together, this research will address several questions central to the urgent challenges facing street-involved youth in North America as a result of the growth of methamphetamine use and illicit drug injecting, and will allow for the evaluation of a range of individual and contextual determinants of HIV risk behavior and STI incidence among this population.