Assessing Patterns of HIV Risk Among IDUs in Neighborhood Environments over Time

描述（由申请人提供）：拟议的研究响应 PAR 07-143“连接环境、行为和 HIV/AIDS 的途径研究”，使用创新方法检查 1987 年至 2005 年旧金山湾区注射吸毒者 (IDU) 和 HIV 预防服务中 HIV 风险行为的时空模式。我们建议对社区特征、社区 HIV 预防服务和 IDU 中个体 HIV 风险行为结果之间的关系进行建模。传统上，对艾滋病毒和非法药物使用的研究仅关注带来风险的个人特征。艾滋病毒和非法药物使用领域的新兴研究表明，在研究个人健康行为时考虑社会环境因素（包括获得医疗保健服务）的重要性。拟议的研究涉及将新出现的空间分析方法应用于二级数据集，以完善关于社区特征如何与街道注射吸毒者获得艾滋病毒预防服务和艾滋病毒风险相关的知识。我们的工作将采用众所周知的弱势群体行为模型，以纳入背景变量和个人行为之间空间相互作用的完善概念化。我们拥有来自 1987 年至 2005 年城市健康研究中对街头注射吸毒者进行的 35,000 次连续横断面访谈的个人水平和艾滋病毒检测数据。其他要使用的数据包括来自美国人口普查、人口普查社区变化数据库、艾滋病毒/艾滋病报告、犯罪报告和艾滋病毒预防服务的地理编码位置（包括艾滋病毒检测点、药物治疗计划和注射器交换计划）的档案数据。具体目标包括具体目标 1：描述 19 年来旧金山湾区人口普查区街道注射吸毒者的社区特征、艾滋病毒预防服务和艾滋病毒危险行为的地理分布；具体目标 2：研究旧金山湾区的社区特征（例如，社区劣势或剥夺）、艾滋病毒预防服务（例如，药物治疗、注射器交换、艾滋病毒检测）和注射吸毒者的艾滋病毒风险行为（例如，共用注射器、无保护性行为）之间的统计关联。目标 1 将涉及创建人口普查区域级地图，以说明关键变量随时间的地理分布。目标 2 将研究社区特征、艾滋病毒预防服务和艾滋病毒危险行为之间的横截面和时间关联。分析方法将包括多级选择偏差模型和空间回归模型。该项目是第一个利用丰富的地理空间背景数据与 19 年个人层面的独特连续横截面数据的项目之一，利用先进的空间分析方法更好地了解背景变量与街头注射吸毒者中艾滋病毒风险行为之间的关系。公共卫生相关性：该项目是第一个利用丰富的地理空间背景数据的项目之一 结合 19 年个人层面的独特连续横截面数据，使用先进的空间分析方法，更好地了解街头注射吸毒者 (IDU) 中的背景变量与 HIV 风险行为之间的关系。这项工作将增进我们对如何使用尖端方法最好地研究这一人群的方法论理解，这些方法检查艾滋病毒危险行为的空间模式以及大都市区邻里环境与艾滋病毒预防服务可用性之间的关系。研究结果将使政策制定者、服务提供商和研究人员受益。

DESCRIPTION (provided by applicant): The proposed study responds to PAR 07-143 "Research on Pathways Linking Environments, Behaviors and HIV/AIDS" by using innovative methods to examine the space-time patterns of HIV risk behaviors among injection drug users (IDUs) and HIV prevention services in the San Francisco Bay Area from 1987 to 2005. We propose to model the relationship among neighborhood characteristics, neighborhood HIV prevention services, and individual HIV risk behavior outcomes among IDUs. Research on HIV and illicit substance use has traditionally focused solely on individual-level characteristics that confer risk. Emerging research in the areas of HIV and illicit substance use has identified the importance of considering social environmental factors, including access to health care services, when studying individual health behaviors. The proposed study involves applying newly emergent spatial analytical methods to secondary datasets in order to refine the knowledge regarding how neighborhood characteristics might be associated with access to HIV prevention services and HIV risk among street-based IDUs. Our work will adapt the well-known Behavioral Model of Vulnerable Populations to incorporate a well-developed conceptualization of the spatial interaction between contextual variables and individual behavior. We have individual-level and HIV test data from 35,000 serial cross-sectional interviews among street-based IDUs from the Urban Health Study from 1987 to 2005. Other data to be used include archival data derived from the U.S. Census, the Census Neighborhood Change Database, HIV/AIDS reports, crime reports, and geocoded locations of HIV prevention services (including HIV testing sites, drug treatment programs, and syringe exchange programs). The specific aims include Specific Aim 1: To describe the geographic distribution of neighborhood characteristics, HIV prevention services, and HIV risk behaviors among street-based IDUs in San Francisco Bay Area census tracts over a 19-year period; and Specific Aim 2: To examine the statistical associations among neighborhood characteristics (e.g., neighborhood disadvantage or deprivation), HIV prevention services (e.g., drug treatment, syringe exchange, HIV testing) and HIV risk behaviors of IDUs (e.g., syringe sharing, unprotected sex) in the San Francisco Bay Area. Aim 1 will involve the creation of census-tract-level maps to illustrate the geographic distributions of key variables over time. Aim 2 will examine the cross-sectional and temporal associations among neighborhood characteristics, HIV prevention services, and HIV risk behaviors. Analytical methods will include multilevel selection bias models and spatial regression models. This project is among the first to utilize a rich set of geospatial contextual data in conjunction with a unique serial cross-section of 19 years of individual-level data, using advanced spatial analytic methods to better understand the relationships between contextual variables and HIV risk behaviors among street-based IDUs. PUBLIC HEALTH RELEVANCE: This project is among the first to utilize a rich set of geospatial contextual data in conjunction with a unique serial cross-section of 19 years of individual-level data, using advanced spatial analytic methods to better understand the relationships between contextual variables and HIV risk behaviors among street-based injection drug users (IDUs). This work will advance our methodological understanding of how best to study this population using cutting-edge methods that examine the spatial patterns of HIV risk behaviors and the relationship between neighborhood context and availability of HIV prevention services in metropolitan areas. The findings will benefit policy makers, service providers, and researchers.