Neighborhood Effects on HIV Risk-Taking

描述（由申请人提供）：艾滋病毒风险降低干预措施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，艾滋病毒/艾滋病的流行并没有停止，尤其是在非裔美国人中，这一群体受到的影响尤为严重。结构性干预措施往往是多层次的，但不太常见，尽管结构性因素往往会造成弱势群体并维持有利于持续参与艾滋病毒危险行为的环境。在拟议的研究中，我们将调查个人如何与邻里环境互动并影响他们的邻里环境。具体来说，我们关注个人和社区环境之间的联系以及结构和环境因素的作用。我们提出了多层次、纵向的设计，具体目标是：（1）调查邻里环境、邻里观念和个人特征与艾滋病毒性冒险之间的关系以及这种冒险与艾滋病毒状况之间的联系； (2) 检查邻里环境、邻里观念、个人特征和注射吸毒相关的 HIV 冒险行为以及这种冒险行为与 HIV 状况之间的关联； (3) 确定艾滋病毒冒险的空间模式，并调查与这些空间模式相关的社区和个人层面的特征。指导概念模型建立在社会解体理论的基础上。招募在 50 个具有不同特征的人口普查街区组中使用有针对性的抽样策略，并作为社区的代理。我们的试点数据显示这些会根据关键特征而变化。此外，我们还将探讨受访者移动的当地背景。研究样本将包括 1,500 名非裔美国女性和男性。将根据吸毒状况、性别以及男性的性取向进行比较。该项目包含不同的数据源，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 1 部分犯罪、毒品逮捕和酒精出口数据。访谈将在三个时间点进行：基线以及 6 个月和 12 个月的随访。将在基线和 12 个月的随访中对犯罪、毒品逮捕和酒精出口数据进行系统观察和审查。分析方法结合了纵向多级分析和空间映射。该研究具有理论和研究意义，因为其研究结果可能为针对社区结构和环境因素的结构干预提供有用的信息，支持现有和新的艾滋病毒预防方法。通过吸纳政策制定者、城市规划者、经济学家、法律专家和更广泛的研究界等合作伙伴，针对艾滋病毒的公共卫生应对措施将得到加强。 公共卫生相关性：拟议的研究重点是个人与邻里环境之间动态且复杂的关系。具体来说，重点是非洲裔美国成年男性和女性（包括男男性行为者和吸毒者）的艾滋病毒风险和艾滋病毒状况。这项多层次、纵向研究将提供必要的信息，为多方面的艾滋病毒风险降低干预措施的制定、实施和评估提供信息，重点是解决结构性和环境风险因素。

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.