HIV RISK AND TRANSITIONS FROM NONINJECTING HEROIN USE

在过去的几年里，非注射使用的情况有所回升 海洛因。仅在纽约市，数以万计的非注射使用者 (NIUS)海洛因有很高的恢复或开始注射的风险 毒品的使用和最终感染人类 免疫缺陷病毒(HIV)和其他血液传播的病原体。他们也 有可能因从事不安全的性行为而被感染。其中包括 谁继续注射，一些新的注射器可能会特别增加 在注射的早期阶段感染艾滋病毒的风险 事业。由于对海洛因NIUS知之甚少，拟议中的研究 将提供有助于制定政策和计划的知识 防止海洛因国家吸毒者向注射毒品过渡，以鼓励那些 谁开始注射，谁停止，并防止他们从事不安全 性。 研究的第一个也是最重要的目标是确定，在 不是当前注射者的海洛因吸毒者，他们 注射吸毒的进展/恢复，以及这种情况的预测因素 前进/倒退。其他目标是确定：(2)和 高危性行为和高危性网络的预测因素，以及 高危性行为和高危性网络的变化；(3) 在那些成为注射者的人中，他们随后参与的程度 高危注射行为和有高危毒品网络，以及 这种行为和网络的预测因素；(4)程度和预测因素 艾滋病毒、乙肝(乙肝)和丙型肝炎(丙型肝炎)的流行感染 曾注射及未曾注射毒品者；及(五) 人类免疫缺陷病毒、乙肝病毒和丙型肝炎病毒感染率及其预测因素 乙肝病毒和丙型肝炎病毒感染，在那些有和没有继续注射的人中。 这项研究将是对纽约1300名海洛因吸毒者的前瞻性队列研究 约克，他将从多个治疗外环境中招募。他们 将接受面试和测试，并在以下位置进行三次后续面试 每隔六个月。将对这些数据进行分析，以预测 使用嵌套病例对照技术和 人-年方法如COX比例风险回归等。 人种学数据将通过实地观察和 密集访谈，并将使用扎根理论进行分析 技巧。 分析的重点将放在确定特定的原因上 诱导或限制NIUS注射(在那些这样做的人中 开始/恢复注射，这是导致特别高风险的因素 行为或在特别高风险的网络中注射毒品)。 可能的原因包括：(1)特定类型的社会关系， 包括社会支持网络和风险网络；(2)具体 社会融合或边缘化的种类；(3)个人 易感因素；以及(4)药品市场状况，如纯度， 可用性和成本。 在这些分析的基础上，将提出建议和建议 开发的目的是防止NIUS进展/恢复为注射。是这样的 这些计划实际上可以拯救数万人的生命。

In the last few years there has been a resurgence in non-injecting use of heroin. In New York City alone, tens of thousands of non-injecting users (NIUs) of heroin are at high risk of reverting to or initiating injecting drug use and of eventually becoming infected with the human immunodeficiency virus (HIV) and other blood-borne pathogens. They also are at risk of becoming infected by engaging in unsafe sex. Among those who go on to inject, some new injectors may be at particularly increased risk of infection with HIV during the early part of their injection careers. Since little is known about heroin NIUs, the proposed research will provide knowledge which can help to develop policies and programs to prevent transitions to drug injecting by heroin NIUs, to encourage those who start to inject to stop, and to prevent them from engaging in unsafe sex. The first and most important aim of the research is to determine, among heroin NIUs who are not current injectors, the rate at which they progress/revert to injecting drug use, and the predictors of such progression/reversion. Other aims are to determine: (2) the extent of and predictors of high-risk sexual behavior and high-risk sexual networks, and of changes in high-risk sexual behavior and high-risk sexual networks; (3) among those who become injectors, the extent to which they then engage in high-risk injecting behaviors and have high-risk drug networks, and the predictors of such behaviors and networks; (4) the extent and predictors of prevalent infection with HIV, hepatitis B (HBV) and hepatitis C (HCV) among those who have and have not previously injected drugs; and (5) the incidence rates of infection with HIV, HBV and HCV, and the predictors of HBV and HCV infection, among those who do and do not go on to inject. The study will be a prospective cohort study of 1,300 heroin NIUs in New York who will be recruited from multiple out-of-treatment settings. They will be interviewed and tested, and given three follow-up interviews at six month intervals. These data will be analyzed for predictors of transitions and incidence rates using nested case-control techniques and person-years methods such as Cox proportional hazards regression. Ethnographic data will be collected through field observation and intensive interviews, and will be analyzed using grounded theory techniques. Analytic emphasis will be placed on determining specific causes that induce or restrain NIUs from injecting (and among those who do begin/revert to injecting, factors that lead to particularly high-risk behaviors or to injecting drugs in particularly high-risk networks). Possible causes include: (1) specific kinds of social relationships, including both social support networks and risk networks; (2) specific kinds of social integration or marginalization; (3) personal susceptibility factors; and (4) drug market conditions such as purity, availability and cost. On the bases of these analyses, suggestions and proposals will be developed to prevent NIUs from progressing/reverting to injecting. Such programs could literally save tens of thousands of lives.