Examining the social, spatial, and temporal context of injection drug use and HIV and HCV risk among people who inject drugs in Ukraine

项目摘要 该项目将使用活动空间方法来探索艾滋病毒/丙型肝炎病毒注射危险行为的差异 以及乌克兰吸毒者(PWID)的保护因素。流行病学报告估计， 在乌克兰，超过三分之一的PWID是艾滋病毒阳性的，68%的PWID是艾滋病毒/丙型肝炎混合感染。药物的使用 乌克兰的情况提出了独特的艾滋病毒/丙型肝炎病毒预防挑战。与世界上许多地方不同，在 乌克兰注射毒品以液体形式出售。经销商可以通过后装或前装的方式分发药品 溶液进入用户的注射器，或者用户可以购买预先装好的注射器中的药物或从 一个普通的容器。乌克兰的PWID通常是以网络成员为群体注射，并在不同的 在一些地方，包括在家里、街道上、俱乐部、空地和小巷里，都有可能出现这种情况。通过他们的日常活动， PWID会遇到不同的地方，有独特的个人组成，从事保护或危险 使行为恶化。此外，社交网络和地点也被认为具有重要作用 在塑造艾滋病毒/丙型肝炎危险行为方面。吸毒者的社交网络在不同地点并不是静态的，而且 基于特定位置的网络组成的不同性质(例如风险级别)以及 该地点的特点(例如，公共或私人)。“活动空间”是指这种独特的 个人在日常活动中直接接触的场所、社交网络和行为。 这项为期两年的研究的具体目的是：1)描述Odesa的PWID的日常生活和日常路径， 乌克兰，并使活动空间清单适应乌克兰的情况；和2)审查#年的差异 按活动空间划分的地点和以自我为中心的网络特征。我们将对30名记者进行深入采访 乌克兰奥德萨的PWID围绕日常生活(他们从事的活动)和日常路径( 他们活动发生的特定地点)，以便了解他们的社会和地点背景 PWID患者的生活，包括吸毒和非吸毒活动。这些数据将被分析以检查 活动空间中HIV/丙型肝炎病毒注射风险和防护行为。然后这些信息将被用于 定量探讨150例PWID患者中地点、社会网络与HIV/丙型肝炎风险的关系 通过活动空间清单。乌克兰毒品使用的独特方面给 为PWID制定有效的艾滋病毒/丙型肝炎预防干预措施这项研究将PWID置于更广泛的 探索他们与吸毒相关的社会网络、规范和行为，以及非吸毒的背景 可能会降低或加剧艾滋病毒/丙型肝炎病毒风险的社会背景。结果将为开发和安置提供信息 针对特定的吸毒环境和相关的社交网络成员量身定做的干预策略 规范。 。

Project Summary This project will use an activity space approach to explore differences in HIV/HCV injection risk behaviors and protective factors among people who use drugs (PWID) in Ukraine. Epidemiological reports estimate that over a third of PWID in Ukraine are HIV-positive, and 68% of PWID are HIV/HCV coinfected. The drug use context in Ukraine presents unique HIV/HCV prevention challenges. Unlike many places in the world, in Ukraine injection drugs are sold in liquid form. A dealer may distribute drugs by backloading or frontloading the solution into users' syringes, or users may purchase drugs in pre-loaded syringes or draw prepared drugs from a common container. Ukrainian PWID typically inject in groups of network members and use drugs in diverse places, including in homes, on streets, in clubs, and in vacant lots and alleys. Through their daily activities, PWID encounter various places with unique compositions of individuals who are engaged in protective or risk exacerbating behaviors. Moreover, social networks and place have been recognized as having important roles in shaping HIV/HCV risk behaviors. Drug users' social networks are not static across locations and have different qualities (e.g., levels of risk) based upon the composition of a network at a particular location and characteristics of that place (e.g., public or private). An “activity space” refers to this unique combination of place, social network, and behavior that individuals have direct contact with as a result of their daily activities. The Specific Aims of this 2 year study are: 1) To describe the daily routine and daily path of PWID in Odesa, Ukraine, and adapt an Activity Space Inventory to the Ukrainian context; and 2) To examine differences in place and egocentric network characteristics by activity space. We will conduct in-depth interviews with 30 PWID in Odesa, Ukraine structured around daily routine (the activities that they engage in) and daily path (the specific places in which their activities occur) in order to understand the social and place-based contexts of PWIDs' lives, including both drug use and non-drug using activities. These data will be analyzed to examine HIV/HCV injection risk and protective behaviors by activity space. This information will then be used to quantitatively explore the relationship between place, social networks, and HIV/HCV risk among 150 PWID through an Activity Space Inventory. The unique aspects of drug use in Ukraine create acute challenges to the development of effective HIV/HCV prevention interventions for PWID. This study places PWID in a broader context that explores both their drug use related social networks, norms, and behaviors, and the non-drug use social context that may diminish or exacerbate HIV/HCV risk. Results will inform development and placement of intervention strategies tailored to specific drug use contexts and associated social network members and norms. .