Social Networks and HIV-infected Former Prison Inmates

描述（由申请人提供）：项目摘要/摘要出狱是一个严重混乱的时期，对感染艾滋病毒的前囚犯以及他们的社会网络和他们返回的社区的福祉构成重大挑战。不仅要解决食物、衣服和住所的紧迫问题，他们还必须重新融入家庭和社会网络。这些挑战对感染艾滋病毒的前囚犯来说尤其严峻，他们除了满足上述需要外，还必须与正规医疗机构建立关系，并设法支付昂贵的医药费。尽管这些人的吸毒和性冒险行为对公共卫生有影响，但对感染艾滋病毒的释放者的危险行为的全面评估很少。我们的初步数据表明，感染艾滋病毒的前囚犯经常有多个性伴侣，安全套使用率很低。大量的研究已经确立了社会网络在定义艾滋病毒风险行为方面的核心作用。基于社会网络的艾滋病毒感染者研究主要依赖于受访者驱动的抽样/招募（RDS）。RDS策略有助于绘制联系图；然而，依靠自我报告来描述被污名化和非法行为的策略面临着重大的局限性。这些方法在描述伙伴关系可能是匿名的网络时尤其成问题。鉴于网络成员之间的相互作用在影响艾滋病毒流行病的传播方面所起的关键作用以及对自我报告行为有效性的关切，需要采用新颖和有力的方法来更全面地了解这些社会结构。在这个R21申请中，我们建议对感染艾滋病毒的前囚犯参与社会网络的生物标志物的效用进行初步评估；具体来说，我们将描述金黄色葡萄球菌（SA）鼻腔定植的分子流行病学特征。我们的目标是确定鼻载SA是否可以用于验证流行病学联系以及确定以前未知的人群之间的联系。在这一系列的试点研究中，我们将：1)表征SA鼻腔定植在250名感染艾滋病毒的囚犯被监禁在北卡罗莱纳州的惩教部门（NCDOC）。2)研究SA基因型与社会网络特征之间的关系。尽管监狱释放者的吸毒和性冒险行为对公共卫生有影响，但对感染艾滋病毒的释放者的危险行为很少进行全面评估。依靠自我报告来描述污名化和非法行为的策略面临重大限制；因此，我们建议对感染艾滋病毒的前囚犯参与社会网络的生物标志物的效用进行初步评估。

DESCRIPTION (provided by applicant): Project Summary/Abstract Release from prison is a time of serious dislocation and significant challenges to the well being of the HIV-infected former inmate as well as to their social networks and the communities to which they return. Not only must the pressing exigent questions of food, clothing and shelter be addressed, s/he must also re- integrate into family and social networks. These challenges are particularly acute for the HIV-infected former inmate who, in addition to meeting the needs described above, must also establish a relationship with a regular source of medical care and find a way to pay for expensive medications. Despite the public health implications of the drug and sexual risk taking of these individuals, there have been few comprehensive assessments of the risk behaviors of HIV-infected releasees. Our preliminary data indicate that HIV-infected former inmates frequently have multiple sexual partners and low rates of condom usage. A large number of studies have established a central role for social networks in defining HIV risk behaviors. Social network-based studies of HIV-infected individuals have relied largely on respondent- driven sampling/recruiting (RDS). RDS strategies have been helpful in mapping connections; however, strategies that rely on self-report to characterize behavior that is stigmatized and illegal face significant limitations. These approaches are particularly problematic in characterizing networks in which partnerships may be anonymous. Given the critical role that interactions between network members play in influencing the spread of the HIV epidemic and the concerns regarding the validity of self-reported behavior, novel and robust approaches are required to provide a more complete understanding of these social structures. In this R21 application, we propose to conduct a preliminary assessment of the utility of a biomarker for social network involvement by HIV-infected former inmates; specifically, we will characterize the molecular epidemiology of nasal colonization with Staphylococcus aureus (SA). Our goal is to determine whether nasal carriage with SA can be used both to verify an epidemiologic connection as well as to identify connections among people that were previously unknown. In this series of pilot studies, we will: 1) Characterize SA nasal colonization among 250 HIV-infected inmates incarcerated in the North Carolina Department of Corrections (NCDOC). 2) Characterize the relationship between SA genotypes and social network characteristics among HIV- infected former inmates who are colonized with SA. Project Narrative Despite the public health implications of the drug and sexual risk taking of prison releasees, there have been few comprehensive assessments of the risk behaviors of HIV-infected releasees. Strategies that rely on self-report to characterize behavior that is stigmatized and illegal face significant limitations; therefore, we propose to conduct a preliminary assessment of the utility of a biomarker for social network involvement by HIV-infected former inmates.