The HIV Risk Behavior and the Urban Environment

描述（由申请人提供）：提出一项多层次的研究，旨在确定城市环境特征与性和药物使用风险因素与HIV感染之间的关系。虽然目前有一些多地点干预研究旨在尽量减少个体高危性行为和吸毒行为，但令人惊讶的是，在控制相关个人水平协变量的情况下，很少有系统的研究探讨城市环境特征、艾滋病毒风险行为和疾病发病率（性传播疾病和艾滋病毒）之间的关系。本研究将考察城市社会环境特征（如收入分配、邻里劣势、种族隔离）和自然环境特征（如人口密度、公共交通、建筑环境）与性和药物使用风险因素（艾滋病毒感染和艾滋病毒和性病流行）之间的独立和相互作用。为了实现研究目标，我们将在四年的时间里从纽约市的24个社区招募2000人（包括目前的吸毒者、过去的吸毒者和从未吸毒的人）。我们将使用聚类分析、人种志绘图和社区咨询来定义社区。参与者将使用一些街头推广技术来招募。个体风险行为和潜在的中介和调节因素将通过面谈进行评估。城市环境的特点将根据人种学评估和利用公开的档案资料（例如，纽约市住房和空缺调查、市长管理报告）进行评估。分层多元模型将用于确定城市环境特征与个人风险行为、艾滋病毒和性病之间的关系。识别影响风险行为的城市环境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，并识别可能表明人口易受艾滋病毒快速传播的城市社区特征。

DESCRIPTION (provided by applicant): Proposed is a multi-level study to determine the association between features of the urban environment and sexual and drug use risk factors for HIV infection. 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 urban environment, HIV 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 social environment (e.g., income distribution, neighborhood disadvantage, racial segregation) and the physical environment (e.g., population density, public transportation, built environment) as they relate to 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 persons (including current drug users, past drug users, and never drug users) from twenty-four New York City neighborhoods over a four year period. We will define neighborhoods using cluster analysis, ethnographic mapping, and community consultation. Participants will be recruited using a number of street outreach techniques. Individual risk behaviors and potential mediators and moderators will be assessed through in-person interviews. Features of the urban environment will be assessed from the ethnographic assessments and 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. 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.