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

描述（由申请人提供）：本申请的目的是评价甲基苯丙胺和一系列社会、结构和环境因素对街头青年开始注射吸毒、HIV风险行为和性传播感染（STI）发病率的影响。在全球范围内，估计有多达1亿的青少年参与街头活动，非法药物使用和相关危害（例如，感染性疾病）一直显示在这一人群中升高。因此，迫切需要数据，为旨在满足这一不断增长的人口的健康需求的干预措施提供信息。特别是，鉴于防止伤害的挑战（例如，因此，迫切需要提供数据，为预防开始注射吸毒的战略提供信息。我们建议在加拿大西部开展这项工作，那里甲基苯丙胺使用的爆炸性增长反映了美国西部使用这种药物的稳定增长。虽然这些趋势是一个日益关注的来源，由于甲基苯丙胺与男性同性性行为和成年注射吸毒者中艾滋病毒风险行为的上升的关系，甲基苯丙胺使用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很难确定。加拿大的温哥华是进行拟议研究的理想地点，原因有几个。首先，该市目前正在经历一个爆炸性的上升，在使用甲基安非他明之间的街头参与的青年，过去的经验表明，毒品市场的趋势在温哥华往往反映在其他美国西部城市，和城市是众所周知的北美入境港的几个非法药物和前体化学品，随后流入美国。因此，这项研究将为美国药物趋势和干预措施提供有价值的数据。温哥华也是一个明显的街头青年问题和街头非法药物市场的所在地，街头青年参与非法药物的风险环境尚未得到充分描述。在此，我们建议创建一个开放的前瞻性队列研究，500名14至25岁的街头青少年将完成一个标准化的问卷调查，并提供生物标本，每半年一次。鉴于当地的药物使用和风险环境的特点，以及当地的实验室能力，我们提出的研究计划提供了一个理想的机会，以检查不断变化的药物使用模式和一系列的社会，结构和环境因素的影响，开始注射毒品使用，性风险行为和性传播感染的发病率。这项研究还提供了一个独特的机会，可以建立一个街头非注射青年群体，从而能够与正在进行的成年注射吸毒者研究进行比较。总之，这项研究将解决几个问题的核心所面临的紧迫挑战，在北美街头参与青年的甲基苯丙胺的使用和非法药物注射的增长的结果，并允许一系列的个人和上下文的艾滋病毒风险行为和性传播感染发病率的决定因素的评估在这一人群中。

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.