NATIONAL STUDY OF SYRINGE EXCHANGE PROGRAMS

在美国，如果不是大多数的话，也有许多新的艾滋病毒感染发生在静脉注射毒品使用者（IDUs）及其性伴侣之间。 三种类型的计划已被证明是有效的，在减少艾滋病毒的危险行为，在这一人群：社区外展，药物滥用治疗和注射器交换计划（SEP）。 已经对社区外展和药物滥用治疗方案进行了国家评估，但值得注意的是，美国没有对SEPs状况进行类似的评估。这项研究旨在填补这一空白。本研究的主要目的是：（1）描述在美国开展的SEP的组织特征，并描述这些项目随时间的变化;（2）评估SEP参与者的人口统计学特征和风险行为;（3）识别与持续或持续风险行为相关的个体水平因素;（4）分析SEP参与者的风险行为。（4）识别与参与者风险相关的SEP组织特征;（5）检查SEP特征与参与者风险行为变化之间的关系;（6）估计大型SEP参与者中的HIV发病率。为达致这些目标，我们会每年对现时在美国经营的SEP的董事进行电话调查。 这将提供关于SEP实施、SEP的组织特征以及SEP提供的服务的最新信息。 我们亦会分层随机抽样访问6间大型及18间中型自雇人士中心的25，920名参与者。 抽样方案将代表美国所有SE活动的大约一半。抽样将受到限制，以提供地理代表性和高与低艾滋病毒血清阳性率之间的注射吸毒者的方案服务。 潜在的受试者将从访问SEPs的人中随机选择。 将获得关于人口特征、吸毒模式以及注射和性风险行为的数据。 音频计算机辅助结构化访谈，一个创新的技术，以增加受访者的隐私，将用于SEP参与者的数据收集。 我们的试点研究（批准R 01 DA 09536）表明，这种方法可以大大减少艾滋病毒风险行为的漏报。这项拟议的研究将是美国第一次对注射器交换规划状况进行国家评估，并将使用创新的数据收集方法，为SEP参与者提供更完整的艾滋病毒风险行为报告。 在研究中获得的信息应该是有用的艾滋病毒预防计划在美国，以及了解已经参加预防计划的人之间的持续风险行为。

Many if not most of the new HIV infections in the US are occurring among intravenous drug users (IDUs) and their sexual partners. Three types of programs have been shown to be effective in reducing HIV risk behaviors in this population: community outreach, drug abuse treatment, and syringe exchange programs (SEPs). National assessments of community outreach and drug abuse treatment programs have been conducted, but notably absent is a similar assessment of the state of SEPs in the US. The proposed research seeks to fill that gap. The proposed research addresses the following specific aims: (1) a description of the organizational characteristics of SEPs operating in the U.S. with a description of change in these programs over time; (2) an assessment of the demographic characteristics and risk behaviors of SEP participants; (3) the identification of individual-level factors associated with continued or persistent risk behaviors; (4) the identification of SEP organizational characteristics associated with risk among participants; (5) an examination of the relationships between SEP characteristics and change in risk behaviors among participants; and (6) an estimation of HIV incidence among participants in large SEPs. To achieve these aims, we will conduct annual telephone surveys of the directors of currently operating SEP in the US. This will provide current information on SEP implementation, organizational characteristics of SEPs, and services offered at SEPs. We will also conduct a stratified random sample of 25,920 interviews of participants in 6 large and 18 medium SEPs. The sampled programs will represent approximately half of all SE activity in the US. The sampling will be constricted to provide geographic representation and high versus low HIV seroprevalence rates among the IDUs served by the programs. Potential subjects will be randomly selected from persons visiting the SEPs. Data on demographic characteristics, drug use patterns and injection and sexual risk behaviors will be obtained. Audio-computer assisted structured interviewing, an innovative technique for increasing respondent privacy, will be used for SEP participant data collection. Our pilot study (grant R01 DA 09536) showed that this method can substantially reduce underreporting of HIV risk behavior. The proposed research will be the first national assessment of the state of syringe exchange programming in the US, and will use innovative data collection method to provide more complete reporting of HIV risk behaviors among SEP participants. The information obtained in the research should be useful for both HIV prevention planning in the US as well as understanding persistent risk behavior among persons already participating in prevention programs.