Initiation of injection drug use and HIV risks among street-involved youth

描述（由申请人提供）：本申请的目的是评估甲基苯丙胺和一系列社会、结构和环境因素对街头青少年开始注射吸毒、艾滋病毒风险行为和性传播感染（STI）发生率的影响。在全球范围内，估计有多达1亿街头青年，非法药物使用和相关危害（例如传染病）在这一人口中一直呈上升趋势。因此，迫切需要数据，以便为旨在满足这一不断增长的人口的健康需求的干预措施提供信息。特别是，鉴于预防青少年开始注射毒品后发生的危害（例如艾滋病毒感染）的挑战，迫切需要数据，以便为预防开始注射吸毒的战略提供信息。我们建议在加拿大西部进行这项工作，在那里，甲基苯丙胺使用的爆炸性增长反映了美国西部使用这种药物的稳步增长。由于甲基苯丙胺与男男性行为者中艾滋病毒风险行为上升和成人注射过量的关系，这些趋势日益引起关注，但甲基苯丙胺使用的流行病学及其与性行为和注射相关艾滋病毒风险行为的关系仍然不明确。由于几个原因，加拿大温哥华非常适合进行拟议的研究。首先，这个城市目前在街头吸毒的年轻人中使用甲基苯丙胺呈爆炸性增长，过去的经验表明，温哥华的毒品市场趋势经常反映在其他美国西部城市，而且众所周知，温哥华是一些非法毒品和前体化学品流入美国的北美入境口岸。因此，这项研究将为美国的药物趋势和干预措施提供有价值的数据。温哥华也是一个巨大而明显的街头青年问题和以街头为基础的非法毒品市场的所在地，而街头青年卷入非法毒品的风险环境尚未得到很好的描述。在此，我们建议建立一个开放的前瞻性队列研究，500名14至25岁的街头青年将完成一份标准化问卷，并提供半年一次的生物标本。考虑到当地的药物使用和风险环境特征，以及当地的实验室能力，我们提出的研究计划为研究不断变化的药物使用模式和一系列社会、结构和环境因素对注射吸毒起始率、性风险行为和性传播感染发生率的影响提供了一个理想的机会。这项研究还提供了一个独特的机会来创建一个街头参与的非注射青年队列，这将与正在进行的成人注射吸毒者研究进行比较。总之，这项研究将解决北美街头青年因甲基苯丙胺使用和非法注射毒品的增长而面临的紧迫挑战的几个核心问题，并将允许评估这一人群中艾滋病毒风险行为和性传播感染发生率的一系列个人和环境决定因素。

DESCRIPTION (provided by applicant): The purpose of this application is to evaluate the impacts of methamphetamine and a range of social, structural, and environmental factors on initiation into injection drug use, HIV risk behavior and sexually transmitted infection (STI) incidence among street-involved youth. Globally, it is estimated that there are as many as 100 million street-involved youth, and illicit drug use and related harms (e.g., infectious diseases) have consistently been shown to be elevated among this population. Thus, there is an urgent need for data to inform interventions aimed at addressing the health needs of this growing population. In particular, given the challenges preventing harms (e.g., HIV infection) that occur after youth begin drug injecting, data to inform strategies to prevent initiation into injection drug use are urgently needed. We propose to undertake this work in a western Canadian setting where the explosive growth in methamphetamine use has mirrored a steady growth in the use of this drug in the western United States. While these trends are a source of growing concern due to methamphetamine's relationship with rising HIV risk behavior among men who have sex with men and adult IDU, the epidemiology of methamphetamine use and its relationship to sexual and injection-related HIV risk behavior remain poorly defined. Vancouver, Canada, is ideally suited for the proposed study for several reasons. First, the city is presently experiencing an explosive rise in the use of methamphetamine among street-involved youth, and past experience demonstrates that drug market trends in Vancouver are often reflected in other western US cities, and the city is known to be a North American port of entry for several illicit drugs and precursor chemicals which subsequently flow into the US. Thus, this research will provide valuable data to inform US drug trends and interventions. Vancouver is also home to a large and visible street-youth problem and street-based illicit drug market, and the risk environment in which street youth become involved in illicit drugs has not been well described. Herein, we propose to create an open prospective cohort study of 500 street-involved youth aged 14 to 25 who will complete a standardized questionnaire and provide biological specimens on a semi-annual basis. Given the local drug use and risk environment characteristics, as well as the local laboratory capacity, our proposed research plan offers an ideal opportunity to examine the impact of evolving drug use patterns and a range of social, structural, and environmental factors on the rates of initiation into injection drug use, sexual risk behavior and STI incidence. This research also presents a unique opportunity to create a cohort of street-involved non-injecting youth which will enable comparisons with an ongoing study of adult injection drug users. Together, this research will address several questions central to the urgent challenges facing street-involved youth in North America as a result of the growth of methamphetamine use and illicit drug injecting, and will allow for the evaluation of a range of individual and contextual determinants of HIV risk behavior and STI incidence among this population. PUBLIC HEALTH RELEVANCE: While increasing methamphetamine use among youth is a source of growing concern due to methampheta- mine's relationship with rising HIV risk behavior among men who have sex with men and adult injection drug users, the epidemiology of methamphetamine use and its relationship to initiation of injection drug use, HIV risk behaviour, and sexually transmitted infection incidence among high-risk youth remains poorly defined. This research will fill this void by evaluating patterns of methamphetamine use and other illicit drug patterns, as well as the risk environment in which drugs are used, to describe their effects on initiation of injection drug use, sexual risk behavior, and incidence of sexually transmitted infections among a cohort of 500 street-involved youth.