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“研究路径连接环境，行为和艾滋病毒/艾滋病”，通过使用创新的方法来检查时空模式的艾滋病毒风险行为之间的注射吸毒者（IDUs）和艾滋病毒预防服务在旧金山弗朗西斯科湾区从1987年至2005年。我们建议建立一个模型来描述注射吸毒者的邻里特征、邻里艾滋病预防服务和个体艾滋病危险行为结果之间的关系。关于艾滋病毒和非法药物使用的研究传统上只侧重于个人一级带来风险的特征。在艾滋病毒和非法药物使用领域的新研究已经确定了在研究个人健康行为时考虑社会环境因素的重要性，包括获得医疗保健服务的机会。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，以完善有关社区特征如何与街头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。我们的工作将适应著名的弱势群体的行为模型，将一个良好的发展概念化的空间之间的相互作用的上下文变量和个人行为。我们从1987年至2005年的城市健康研究中对35,000名街头注射吸毒者进行了连续横断面访谈，获得了个人水平和HIV检测数据。其他使用的数据包括来自美国人口普查的档案数据，人口普查邻里变化数据库，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（包括艾滋病毒检测站，药物治疗计划和注射器交换计划）。具体目标包括：具体目标1：描述19年期间旧金山弗朗西斯科人口普查区街道注射吸毒者的邻里特征、艾滋病毒预防服务和艾滋病毒风险行为的地理分布;具体目标2：检查邻里特征之间的统计关联（例如，邻里的劣势或贫困），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危险行为（例如，注射器共享，无保护的性行为）在弗朗西斯科湾区。目标1将涉及制作普查区一级的地图，以说明关键变量随时间的地理分布情况。目标2将研究邻里特征、艾滋病预防服务和艾滋病风险行为之间的横向和时间关联。分析方法将包括多水平选择偏差模型和空间回归模型。该项目是第一个利用一套丰富的地理空间背景数据，结合19年个人层面数据的独特系列横截面，使用先进的空间分析方法，以更好地了解街头注射吸毒者之间的背景变量和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集的项目之一， 结合19年个人层面数据的独特系列横截面，使用先进的空间分析方法，以更好地了解街头注射毒品使用者（IDUs）之间的背景变量和艾滋病毒风险行为之间的关系。这项工作将推进我们的方法论的理解，如何最好地研究这一人群使用先进的方法，检查艾滋病毒风险行为的空间模式和邻里环境之间的关系和大都市地区的艾滋病毒预防服务的可用性。研究结果将使政策制定者、服务提供者和研究人员受益。

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.