Drug Use, Housing Access, Stability and HIV Risk among Low-Income Urban Residents

描述(申请人提供)：这项为期4年的研究题为“低收入城市居民的药物使用、住房获得、稳定性和艾滋病毒风险”，目的是探索住房的结构性因素(获得住房补贴和计划的机会、地位和稳定性)与吸毒者艾滋病毒风险之间的关系。拟议中的项目将检验一些假设，即吸毒者获得联邦、州和地方住房补贴和计划的机会比低收入的非吸毒者更少，以及住房不稳定会增加吸毒者感染艾滋病毒的风险。这项研究的具体目的包括：1)比较低收入吸毒者和低收入非吸毒者在控制个人特征的两个研究城镇中获得住房和社会服务的机会，以及他们的住房随时间的稳定性；2)考察住房获得在吸毒和住房状况/稳定性之间的中介关系；3)考察住房状况与吸毒和非吸毒低收入居民感染艾滋病毒风险的关系；4)探讨不同支持性住房项目在项目要求和提供的支持性服务方面的差异，及其对申请者获得支持性住房项目、维护住房稳定、吸毒和艾滋病毒危险行为的影响。为了探索这4个目标，我们将对哈特福德和东哈特福德的300名吸毒和150名非吸毒低收入居民在基线、6个月和12个月进行纵向调查。两个社区的低收入居民将通过有针对性的抽样，使用探索性定性研究中开发的工具(R21 DA 018607)进行招募。作为更大样本的一部分，我们将超额招募100名保障性住房计划的居民，直接在提供保障性住房的机构招聘，以确保有足够的样本规模。这项调查包括详细衡量住房状况和稳定性、获得住房补贴、支持性住房、福利和健康福利、社区特征、健康和心理健康状况、药物使用和艾滋病毒危险行为。此外，我们将通过绘制二级住房数据和使用地理空间分析对住房可用性进行建模，探索社区一级的住房准入(租赁住房数量、空置率、支持性住房和低收入住房数量、避难所数量)。还将通过绘制与毒品有关的逮捕和暴力逮捕事件的地图和地理空间模型，并根据参与者的住所或无家可归者最经常过夜的地点/S，评估被遗弃建筑物的位置，从而在社区一级评估风险。为了更全面地探索作为目标4一部分的不同支持性住房计划在理念和计划要求方面的差异，我们将对研究城镇中5个支持性住房计划的每一个服务提供者进行深入访谈。这一探索性目标将使我们能够制定措施和关系，以便在后续研究中更全面地评估不同的支持性住房计划。该项目提供的信息将有助于查明限制吸毒者获得住房并导致其住房不稳定的结构性条件。这些信息将大大有助于制定干预措施，以减少吸毒者易受艾滋病毒感染的一些根本原因，包括为无家可归风险较高的活跃吸毒者开发新的住房替代方案、针对无家可归吸毒者的背景风险因素的艾滋病毒预防干预措施，以及改善吸毒者获得住房和整体健康的政策建议。

DESCRIPTION (provided by applicant): The purpose of this 4 year study entitled "Drug Use, Housing Access, Stability and HIV Risk among Low- Income Urban Residents" is to explore the relationship between structural factors of housing (access to housing subsidies and programs, status and stability) and HIV risk among drug users. The proposed project will test hypotheses that drug users have less access to federal, state and local housing subsidies and programs than low-income non-drug users, and that housing instability increases drug users' HIV risk. The specific aims of the proposed study include the following: 1) To compare low-income drug users' and low- income non-drug users' access to housing and social services, and their housing stability over time in the two study towns controlling for personal characteristics; 2) To examine the mediating relationship of housing access between drug use and housing status/stability; 3) To examine the relationship between housing status and HIV risk for drug using and non-drug using low-income residents; and 4) To explore differences in program requirements and supportive services offered by different supportive housing programs and their impact on applicants' access to supportive housing programs, maintenance of housing stability, and drug use and HIV risk behaviors. To explore these 4 aims, we will conduct longitudinal surveys with a cohort of 300 drug using and 150 non-drug using low-income residents of Hartford and East Hartford at baseline, 6 and 12 months. Low-income residents of the two communities will be recruited through targeted sampling, using an instrument developed in an exploratory qualitative study (R21 DA 018607). We will over-recruit 100 residents of supportive housing programs as part of this larger sample by directly recruiting at the agencies that provide supportive housing in order to ensure sufficient sample size. The survey includes detailed measures of housing status and stability, access to housing subsidies, supportive housing, welfare and health benefits, neighborhood characteristics, health and mental health status, drug use and HIV risk behaviors. In addition, we will explore housing access at the neighborhood level (number of rental housing units, vacancy rates, number of supportive and low-income housing, number of shelters) by mapping secondary housing data and modeling housing availability using geospatial analysis. Risk will also be assessed at the neighborhood level by mapping and geospatial modeling of drug related and violent arrests, and locations of abandoned buildings in relation to participants' residences or, if homeless, the location/s where they most frequently spend the night. In order to explore more fully the differences in philosophy and program requirements of different supportive housing programs as part of aim 4, we will conduct in-depth interviews with service providers in each of the 5 supportive housing programs in the study towns. This exploratory aim will allow us to develop measures and relationships to more fully evaluate different supportive housing programs in a subsequent study. Information from this project will allow identification of structural conditions that limit drug users' access to housing and contribute to their housing instability. Such information will contribute significantly to the development of interventions to reduce some of the root causes of drug users' vulnerability to HIV infection, including developing new housing alternatives for active drug users at high risk for homelessness, HIV prevention interventions that address contextual risk factors of homeless drug users, and policy recommendations to improve drug users' access to housing and overall health.