Neighborhood Effects on HIV Risk-Taking

社区对艾滋病毒冒险行为的影响

• 批准号: 8076330
• 负责人: CLAIRE E STERK
• 金额: $ 64.62万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-20 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8076330
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; African American; Alcohol consumption; Alcohols; Area; Behavior; Behavioral; Cardiovascular system; Censuses; Characteristics; Communities; Complex; Crime; Data; Data Sources; Development; Disadvantaged; Disease; Drug usage; Drug user; Enrollment; Environment; Environmental Risk Factor; Epidemic; Evaluation; Gender; Goals; HIV; Health; Home environment; Hot Spot; Individual; Injecting drug user; Injection of therapeutic agent; Intervention; Interview; Lead; Legal; Link; Longitudinal Studies; Malignant Neoplasms; Maps; Modeling; Nature; Neighborhoods; Obesity; Pattern; Perception; Pharmaceutical Preparations; Policy Maker; Prevention approach; Prevention strategy; Process; Proxy; Public Health; Research; Research Infrastructure; Research Personnel; Respondent; Risk; Risk Behaviors; Risk Reduction; Risk-Taking; Role; Sampling; Sampling Studies; Sex Orientation; Social Disorganizations; Social Environment; Stigmata; Time; Vulnerable Populations; Woman; base; empowered; follow-up; housing instability; longitudinal design; member; men; men who have sex with men; public health relevance; response; sex; social; social capital; social stigma; success; theories

DESCRIPTION (provided by applicant): HIV risk-reduction interventions traditionally have emphasized individual-centered behavioral prevention approaches. Despite their success, the HIV/AIDS epidemic has not come to a halt, especially not among African Americans, a group that is disproportionately impacted. Structural interventions, which tend to be multilevel, are less common even though structural factors often create vulnerable populations and sustain an environment that is supportive of continued engagement in HIV risk behaviors. In the proposed study, we will investigate how individuals interact with and impact their neighborhood environments. Specifically, we focus on the link between the individual and neighborhood context and the role of structural and environmental factors. We propose a multilevel, longitudinal design and the specific aims are: (1) to investigate the relationships between neighborhood context, neighborhood perceptions, and individual characteristics, and HIV sexual risk-taking and the link between this risk-taking and HIV status; (2) to examine the association between neighborhood context, neighborhood perceptions, individual characteristics, and injection drug use related HIV risk-taking and this risk-taking and HIV status; and (3) to identify the spatial patterns of HIV risk-taking and to investigate neighborhood and individual-level characteristics associated with these spatial patterns. The guiding conceptual model builds on social disorganization theory. Recruitment uses targeted sampling strategies across 50 census block groups, with varied characteristics, and which serve as a proxy for neighborhoods. Our pilot data show these to vary according to key characteristics. In addition, we will explore the local context in which the respondents move. The study sample will consist of 1,500 African American women and men. Comparisons will be drawn based on drug use status, gender, and among the men, sexual orientation. The project comprises distinct data sources, namely: individual interviews, individual HIV status, systematic observations, data from the 2000 U.S. Census, and part 1 crime, drug arrests, and alcohol outlet data. Interviews will be conducted at three time points: baseline and 6 and 12 month follow-up. Systematic observations and a review of crime, drug arrests and alcohol outlet data will occur at baseline and at 12 month follow-up. The analytical approach combines longitudinal multilevel analyses and spatial mapping. The study has theoretical and research significance as its findings may provide useful information for structural interventions, targeting neighborhood structural and environmental factors, that support existing and new HIV prevention approaches. By incorporating partners such as policy-makers, urban planners, economists, legal experts and the wider research community, the public health response to HIV will be enhanced. PUBLIC HEALTH RELEVANCE: The proposed study focuses on the dynamic and complex relationship between individual and neighborhood context. Specifically, the focus is on HIV risk-taking and HIV status among adult African American men and women, including men-who-have-sex-with-men and drug users. The multilevel, longitudinal study will provide information necessary to inform the development, implementation and evaluation of multifaceted HIV risk-reduction interventions, with an emphasis on addressing structural and environmental risk factors.

描述（由申请人提供）：降低HIV风险的干预传统上强调以个人为中心的行为预防方法。尽管取得了成功，但艾滋病毒/艾滋病的流行并没有停止，特别是在非洲裔美国人中，这一群体受到的影响尤为严重。结构性干预往往是多层次的，但不太常见，尽管结构性因素往往会造成弱势群体，并维持一个支持继续参与艾滋病毒风险行为的环境。在拟议的研究中，我们将调查个人如何与他们的社区环境相互作用和影响。具体而言，我们关注个人和社区背景之间的联系以及结构和环境因素的作用。本文提出多层次纵向设计，具体目的是：(1)探讨社区环境、社区认知和个体特征与HIV性行为风险之间的关系，以及这种风险与HIV感染状况之间的关系；(2)研究社区环境、社区认知、个体特征与注射吸毒相关HIV风险及其与HIV感染状况的关系；(3)确定HIV风险承担的空间格局，并调查与这些空间格局相关的社区和个人水平特征。指导概念模型建立在社会无序理论的基础上。招募人员在50个人口普查街区群体中采用有针对性的抽样策略，这些群体具有不同的特征，并作为社区的代表。我们的试验数据显示，这些因素因关键特征而异。此外，我们将探讨受访者移动的当地背景。研究样本将包括1500名非裔美国男女。将根据药物使用状况、性别以及男性的性取向进行比较。该项目包括不同的数据来源，即：个人访谈、个人艾滋病毒状况、系统观察、2000年美国人口普查数据以及第一部分犯罪、毒品逮捕和酒精销售数据。访谈将在三个时间点进行：基线和6个月和12个月的随访。将在基线和12个月随访期间对犯罪、毒品逮捕和酗酒数据进行系统观察和审查。分析方法结合纵向多层次分析和空间映射。该研究具有理论和研究意义，因为其发现可能为结构性干预提供有用的信息，针对社区结构和环境因素，支持现有和新的艾滋病毒预防方法。通过纳入决策者、城市规划者、经济学家、法律专家和更广泛的研究界等伙伴，将加强对艾滋病毒的公共卫生反应。