Male IDUs in Viet Nam: Ethno-Epidemiology of HIV Risk

描述(申请人提供)：东南亚地区与高风险注射毒品做法相关的意外医疗后果迅速增加，包括在注射吸毒者人群中流行的病毒病原体，如艾滋病毒-1、乙肝病毒和丙型肝炎病毒的流行率和发病率增加。这些趋势引起了人们对艾滋病毒感染在东南亚未来传播的严重关切，并可能预示着该区域出现一种自我维持的流行病。特别令人关切的是，越南年轻男性海洛因注射吸毒者的新感染人数迅速增加。作为NDRI艾滋病毒研究人员与河内医科大学公共卫生研究人员和社区医生之间的一项独特合作，这项研究具有双重目标，即发展年轻男性海洛因吸毒者中注射媒介风险的流行病学概况，同时提高越南研究人员应对注射吸毒者中新出现的艾滋病毒流行的技术能力。拟议示范项目的具体目标包括：[1]建立青年男子使用鸦片、吗啡碱和海洛因等鸦片类药物的物理环境、情景事件、社会团体和经济交流的流行病学类型，以及关于注射这些物质中艾滋病毒风险的知识、态度和信念；[2]描述在制备和注射海洛因类药物解决方案时所采用的行为做法的变异性，包括当地毒品营销模式、药物获取战略和可能促进血液传播病原体的药物分享做法；[3]描述注射者作为注射海洛因学徒的个人、社会和经济相关性，包括注射吸毒者学习准备和注射海洛因的教学过程，他们开始和维持注射作为一种药物(海洛因)给药模式的理由，以及海洛因依赖的早期社会过程；[4]描述与海洛因注射开始有关的意外医疗后果的积累，特别是注射吸毒者人群中流行的艾滋病毒和其他病毒病原体；[5]推广借鉴人类学人种学的概念和方法，在美国“未接受治疗”人群中开展流行病学研究，目的是加强越南研究人员在查明和监测与药物滥用和艾滋病毒有关的新趋势方面的技术能力。

DESCRIPTION (provided by applicant): South East Asia has witnessed a rapid increase in unintended medical consequences associated with high-risk drug injection practices, including increases in the prevalence and incidence of viral pathogens prevalent in IDU populations such as HIV-1, HBV, and HCV. These trends raise grave concerns about the future spread of HIV infection in South East Asia and may portend the emergence of a self-sustaining epidemic in the region. Of particular concern, is the rapid increase in new infections among young, male heroin IDUs in Viet Nam. Structured as a unique type of collaboration between HIV researchers at NDRI and public health researchers and community-based physicians at Hanoi Medical University, this study has the dual goal of developing an epidemiological profile of injection-mediated risk among young male heroin users, while simultaneously advancing the technical capacity of researchers in Viet Nam to respond to the emerging HIV epidemic among IDUs. Specific aims of the proposed demonstration project include: [1] To develop an epidemiological typology of the physical settings, situational events, social groups, and economic exchanges, in which young men use opiate-based drugs, including opium, morphine-base, and heroin, as well as the knowledge, attitudes, and beliefs regarding HIV risk in the injection of these substances; [2] To describe variability in behavioral practices employed in the preparation and injection of heroin-based drug solutions, including local drug marketing patterns, drug-acquisition strategies, and drug-sharing practices that may facilitate transmission of blood-borne pathogens; [3] To describe individual, social, and economic correlates of injectors' apprenticeship into heroin injection, including the pedagogical processes in which IDUs learn to prepare and inject heroin, their rationale for initiating and maintaining injection as a mode of drug (heroin) administration, and the early social course of heroin dependence; [4] To describe the accumulation of unintended medical consequences associated with the onset of heroin injection, particularly HIV and other viral pathogens prevalent among IDU populations; and [5] To extend concepts and methods adapted from anthropological ethnography in conducting epidemiological research among "out-of-treatment" populations in the U.S., with the goal of enhancing the technical capacity of researchers in Viet Nam in identifying and monitoring emerging trends associated with drug abuse and HIV.