Risk Factors for AIDS among Drug Users: Getting Close to Zero

 联合国艾滋病规划署宣布了一个新的艾滋病毒感染为零的目标，克林顿国务卿宣布了一个无艾滋病一代的目标。在艾滋病毒高风险人群中完全消除新的艾滋病毒感染可能是不可能的，但综合预防，包括治疗即预防（TasP）可能使新的艾滋病毒感染接近零。精神活性药物的使用产生了许多障碍，几乎为零。吸毒可通过共用注射设备和与吸毒有关的不安全性行为导致艾滋病毒感染。药物使用也可能干扰获得和坚持抗逆转录病毒治疗（ART）。精神活性药物的使用也与少数种族/族裔中艾滋病毒感染率较高密切相关。在这项研究中，我们将研究联合预防是否可以在纽约市的注射和非注射毒品使用者中获得接近零的新艾滋病毒感染，包括接近零是否可以最大限度地减少种族/民族差异。 如果联合预防确实导致纽约市吸毒者的新感染接近零。这将需要：（a）对综合预防进行分析性描述;（B）对接近于零的情况进行明确的概念化;（c）评估接近于零的情况的新的衡量标准和方法。 我们将研究通过四个具体目标使纽约市吸毒者的新艾滋病毒感染接近零：1。确定纽约市艾滋病毒注射相关传播的综合预防接近于零的程度。制定新的衡量标准，以衡量注射相关传播的CtZ情况，以及如何最大限度地减少种族/民族差异。2.进行数学建模，使用高注入风险的生物标志物（HCV感染）和高性风险（HSV-2感染）和行为数据，以分析PWID中的HIV感染：（1）残疾人群体作为一个整体，（2）主要种族/族裔群体之间的差异，（3）通过综合预防维持CTZ状况的可持续性，（4）艾滋病毒在艾滋病感染者中的注射传播与性传播。3.确定“综合预防”在多大程度上减少了纽约市非注射毒品使用者（NIDUs）和PWID中与毒品有关的性传播艾滋病毒。制定衡量持续性传播潜力的新指标，并评估非吸毒者中“以治疗为预防”（TasP）的覆盖率。监测HSV-2感染作为吸毒性传播持续驱动因素的趋势。4.利用地理空间分析来描述纽约市吸毒者中艾滋病毒持续传播的“热点”，包括艾滋病毒注射相关传播和性传播之间的潜在地理重叠，以及热点的种族/民族和艾滋病毒服务特征。 我们将通过每年对600名受试者进行面谈和HIV、HCV和HSV-2检测，以及继续与纽约市和州卫生部门的长期合作来实现这些目标。

 DESCRIPTION: UNAIDS has announced a goal of Getting to Zero New HIV infections and Secretary Clinton has announced a goal of an AIDS free generation. Completely eliminating new HIV infections may not be possible in any large population of persons at high risk for HIV, but combined prevention, including treatment as prevention (TasP) may permit getting very close to zero new HIV infections. Psychoactive drug use generates many impediments getting close to zero. Drug use can lead to HIV infection through both sharing injection equipment and through drug use related unsafe sexual behavior. Drug use may also interfere with accessing and adhering to antiretroviral therapy (ART). Psychoactive drug use is also strongly associated with higher rates of HIV infection among racial/ethnic minorities. In this research, we will examine whether combined prevention can get close to zero new HIV infections among injecting and non-injecting drug users in New York City, including whether getting close to zero can minimize racial/ethnic disparities. If combined prevention does lead to getting close to zero new infections drug users in NYC. This will require a) an analytic description of combined prevention, b) a clear conceptualization of getting close to zero, and c) new metrics and methods for assessing being close to zero. We will study getting close to zero new HIV infections for drug users in NYC through four specific aims: 1. Determine the extent to which combined prevention is getting close to zero for injecting related transmission of HIV in NYC. Develop new metrics for measuring a CtZ situation for injecting-related transmission and how racial/ethnic disparities might be minimized. 2. Conduct mathematical modeling, using biomarkers for high injecting risk (HCV infection) and high sexual risk (HSV-2 infection) and behavioral data to analyze HIV infection among PWID in terms of: 1) the PWID population as a whole, 2) disparities among major racial/ethnic groups, 3) sustainability for maintaining a CTZ situation with combined prevention, and 4) injecting related vs. sexual transmission of HIV among PWID. 3. Determine the extent to which "combined prevention" is reducing drug related sexual (DRS) transmission of HIV among non-injecting drug users (NIDUs) and PWID in NYC. Develop new metrics for measuring the potential for continuing sexual transmission and assess coverage of Treatment as Prevention (TasP) among NIDUs. Monitor trends in HSV-2 infection as a continuing driver of drug use sexual transmission. 4. Utilize geospatial analysis to characterize "hotspots" for continuing transmission of HIV among drug users in NYC, including potential geographic overlap between injecting related and sexual transmission of HIV, and racial/ethnic and HIV service characteristics of hotspots. We will accomplish these aims through interviews and HIV, HCV, and HSV-2 testing of 600 subjects per year and continuation of our long-standing collaborations with the NY City and State Health Departments.