HIV Disparities among Drug Users: Neighborhoods, Neurocognition and Sex Behavior

描述(由申请人提供)：这份R03申请建议进行二次数据分析，以开发统计模型，解释在非裔美国人和白人物质使用者中发现的艾滋病毒/艾滋病差异。在拟议的研究中，我们将使用高级统计分析(潜在变量混合模型)来考虑邻里因素(毒品拦截率和贫困)、药物使用模式和神经认知功能对性风险伙伴关系以及反过来对艾滋病毒/艾滋病的单独和协同影响。首先，我们将评估不同的社区因素(隔离、毒品市场、贫困)与性伙伴关系和艾滋病毒/艾滋病之间可能存在的特殊性。这项研究的目标2是模拟社区特征、药物使用模式、监禁和神经认知功能对性风险伙伴关系的影响，并估计18个月期间的患病率和发病率。第三个目标是估计性伙伴关系与感染艾滋病毒之间的关联程度。考虑了修改效果的可能性，重点是种族和性别。如果成功，该项目将通过以下方式改进预防科学：(1)增加吸毒者对性风险伙伴关系以及它们在种族和性别之间的差异的了解；(2)通过强调毒品对性伙伴关系的背景影响(例如毒品逮捕率)的重要性，支持在试图了解艾滋病毒中的种族差异时考虑传统SES指标之外的因素；以及(3)指定可能调解/调节邻里关系、物质使用和性风险伙伴关系的潜在神经认知过程。这项研究是一系列创新研究中的第一项，旨在解释非裔美国人的种族差异和预防艾滋病毒/艾滋病。 与公共健康相关：药物使用和艾滋病毒之间的交集是一个主要关切，因为毒品网络的核心和外围成员占艾滋病毒/艾滋病病例的很大一部分。尽管所有参与毒品网络的人感染艾滋病毒的风险都增加了，但非洲裔美国人往往受到不成比例的影响。由于仅以个人为重点的干预措施在减缓艾滋病毒在非裔美国人中的传播方面取得的成功有限，因此必须阐明社会和人际因素影响艾滋病毒感染的影响并建立途径模型。

DESCRIPTION (provided by applicant): This R03 application proposes to conduct secondary data analysis to develop statistical models that explain disparities in HIV/AIDS found among African American and white substance users. In the proposed study, we will employ advance statistical analyses (latent variable mixture models) to consider the separate and synergistic influence of neighborhood factors (drug arrest rates and poverty), substance use patterns and neurocognitive functioning on sexual risk partnerships and, in turn, HIV/AIDS. First, we will evaluate the possible specificity in relationships between distinct neighborhood level factors (segregation, drug markets, poverty) and sexual partnerships and HIV/AIDS. Aim 2 of the study is to model the influence of neighborhood characteristics, substance use patterns, incarceration and neurocognitve functioning on sexual risk partnerships and estimate prevalence and incidence over an18-month period. The third aim is to estimate the magnitude of the association between sexual partnerships and being HIV-infected. The possibility of effect modification is considered with a focus on race and gender. If successful, this project should improve prevention science by: (1) increasing understanding of sexual risk partnerships among drug users and how they vary across race and gender; (2) providing support for considering factors beyond traditional SES indicators when attempting to understand racial disparities in HIV by highlighting the importance of contextual influences of drugs (e.g., rate of drug arrests) on sexual partnerships; and (3) specifying potential neurocognitive processes that might mediate/moderate the relationship between neighborhood, substance use and sexual risk partnerships. This study is the first in a series of innovative studies designed to explain racial disparities and prevent HIV/AIDS among African Americans. PUBLIC HEALTH RELEVANCE: The intersection between substance use and HIV is a major concern as core and peripheral members of drug networks represent a significant portion of HIV/AIDS cases. Although all persons involved in drug networks are at increased risk for HIV, African Americans tend to be disproportionately affected. Because interventions focused solely on the individual have had limited success in slowing the spread of HIV among African Americans, it is important to elucidate the influence and model the pathways through which social and interpersonal factors influence HIV acquisition.