HIV Risk, Drug Use, Social Networks: Homeless Persons Transitioned to Housing

描述（由申请人提供）：我们利用社会生态模型来了解长期无家可归者（主要是非裔美国男性和女性）在过渡到永久性支持性住房（PSH）中的艾滋病风险和预防行为的纵向变化。无家可归者面临着不成比例的艾滋病毒和吸毒风险。PSH旨在为这一弱势群体提供综合保健服务，但几乎没有研究了解居民中的艾滋病毒风险和预防，也没有研究在PSH内提供艾滋病毒预防服务，除了专门为艾滋病毒/艾滋病感染者提供的服务。一些证据表明，随着时间的推移，过渡到住房可能会增加而不是减少风险行为，尽管没有研究来澄清这些复杂性。具体目的如下：1)研究过渡到PSH与HIV风险和预防行为之间的关系；2)研究PSH转变与PSH居民社会网络变化的关系，以及PSH居民社会网络与HIV风险和预防行为变化的关系；3)研究PSH的转变与PSH居民药物使用和心理健康症状的变化之间的关系，以及这些个体特征的变化与HIV风险和预防行为之间的关系；4)确定PSH提供者是否以及如何促进HIV预防，并了解可能影响居民HIV风险的政策和程序；5)综合目标1- 4的研究结果，为PSH居民提供降低艾滋病毒传播风险和加强艾滋病毒预防服务的具体策略。目标1-3将通过结构化访谈（基线、3、6、12个月）和连续入院的PSH（12个月时N=405）来解决。目标4将通过与PSH项目的管理人员（N=30）和与一线工作人员（N=100）的焦点小组进行个别访谈，以及对PSH居民（N=30）进行人种学跟踪来解决。目标5将通过50名PSH供应商和50名居民的焦点小组，综合目标1-4的结果。

DESCRIPTION (provided by applicant): We utilize a social ecological model to understand longitudinal changes in HIV risk and prevention behaviors among chronically homeless, predominantly African American men and women who transition into permanent supportive housing (PSH). Homeless persons face disproportionate risk of HIV and drug use. PSH is intended as the locus of integrated health services for this vulnerable population, yet there has been almost no research to understand HIV risk and prevention among residents, or the provision of HIV prevention services within PSH, except specifically for people living with HIV/AIDS. Some evidence suggests that transitioning to housing could increase rather than decrease risk behaviors over time, although research to clarify these complexities is absent. Specific Aims are as follows: 1) To examine how transition to PSH is associated with HIV risk and prevention behaviors over time; 2) To examine how transition to PSH is associated with changes in social networks of PSH residents, and how networks are associated with changes in HIV risk and prevention behaviors over time; 3) To examine how transition to PSH is associated with changes in drug use and mental health symptoms among PSH residents, and how changes in these individual characteristics are associated with HIV risk and prevention behaviors over time; 4) To determine whether and how PSH providers promote HIV prevention, and to understand policies and procedures that may impact HIV risk among residents; 5) To synthesize findings from Aims 1- 4 to inform specific strategies to reduce risk of HIV transmission and to enhance HIV prevention services for residents in PSH. Aims 1-3 will be addressed through structured interviews (baseline, 3, 6, 12 months) with consecutive admissions to PSH (N=405 at 12 months). Aim 4 will be addressed through individual interviews with supervisory staff (N=30) and focus groups with front line staff (N=100) of PSH programs, and ethnographic shadowing of PSH residents (N=30). Aim 5 will synthesize findings of Aims 1-4 through focus groups with 50 PSH providers and 50 residents.