The HIV Risk Behavior and the Urban Environment

描述(由申请人提供)：建议进行一项多层次研究，以确定城市环境特征与习惯性吸毒者感染艾滋病毒的性和药物使用风险因素之间的联系。最近的证据表明，性危险行为在艾滋病毒传播中的作用越来越大，甚至在习惯使用毒品的人群中也是如此，这表明对性和毒品风险的决定因素及其与艾滋病毒传播的关系进行更全面的研究是重要的。尽管目前有几项旨在将个人高危性行为和吸毒行为降至最低的多地点干预研究，但令人惊讶的是，在控制相关个人水平的协变量的同时，很少有系统性研究探索个人环境特征、她/他的危险行为与疾病发病率(性传播疾病和艾滋病毒)之间的关系。这项研究将审查城市物理环境特征(如人口密度、公共交通、住房质量)和社会环境特征(如暴力、治安、收入分配、社区不利)的独立和交互影响，因为它们与性伴侣动态、艾滋病毒感染的性和药物使用风险因素以及艾滋病毒和性传播疾病的流行有关。为了达到这项研究的目标，我们将从纽约市的八个社区招募2000名习惯性吸毒者(包括注射者和非注射者)，在四年内采用多阶段抽样，以便进行时间趋势分析。将使用可公开获得的档案信息(例如，纽约市住房和空置调查、市长管理报告)对城市环境的特征进行评估。将使用分层多变量建模来确定城市环境特征与个人危险行为、艾滋病毒和性传播疾病之间的关系。我们还将建立城市特征变化与当前行为之间的关联模型。确定塑造危险行为的城市环境的关键特征可以指导结构性干预，提高个人层面行为干预的效率，并确定可能表明人口易受艾滋病毒快速传播影响的城市社区特征。

DESCRIPTION (provided by applicant): Proposed is a multi-level study is to determine the association between features of the urban environment and sexual and drug use risk factors for HIV infection among habitual drug users. Recent evidence about the growing role of sex risk behavior in the transmission of HIV, even among habitual drug using populations, suggests that more comprehensive studies of the determinants of both sex and drug risks, and their relationship to HIV transmission, are important. Although there are at present several multi-site intervention studies that aim to minimize individual high risk sex and drug-use behavior, surprisingly little systematic research has explored the relation between features of the individual's environment, her/his risk behavior, and disease morbidity (sexually transmitted diseases and HIV) while controlling for relevant individual-level covariates. This study will examine the independent and interactive effect of features of the urban physical environment (e.g., population density, public transportation, housing quality) and of features of the social environment (e.g., violence, policing, income distribution, neighborhood disadvantage) as they relate to sexual partner dynamics, sexual and drug use risk factors for HIV infection, and to HIV and STD prevalence. To address the study aims, we will recruit 2,000 habitual drug users (including injectors and non-injectors) from eight New York City neighborhoods using multi-stage sampling over a four year period to allow for temporal trend analysis. Features of the urban environment will be assessed using publicly available archival information (e.g., New York City Housing and Vacancy Survey, Mayor's Management Report). Hierarchical multivariate modeling will be used to determine the relations between features of the urban environment and individual risk behavior, HIV, and STDs. We will also model the associations between changing features of the city and current behavior. Identification of the key features of the urban environment that shape risk behavior can guide structural interventions, increase the efficiency of individual-level behavioral interventions, and identify features of urban neighborhoods that could suggest population vulnerability to rapid transmission of HIV.