Spatial Variations in IDU HIV Risk: Relationship to Structural Interventions

描述(由申请人提供)：非法吸毒者从事与毒品有关的艾滋病毒危险行为或遭受与毒品有关的不良健康后果的可能性在不同社区有很大不同。虽然一项新兴的研究已经调查了特定的社区层面的特征(例如，破旧的住房和社会混乱的存在)是否决定了这些与毒品有关的行为和健康结果的社区层面的差异，但尚未有研究研究注射器获取(SA)方案或与毒品相关的刑事司法(D-RCJ)活动是否有助于包括注射吸毒者(IDU)在内的非法吸毒者在社区层面的与毒品相关的行为和健康结果的差异。这种缺失是惊人的：(1)SA方案和D-RCJ活动影响与毒品相关的健康行为、结果和服务使用的模式；(2)SA方案和D-RCJ活动是以地点为基础的结构性干预：它们在不同社区分布不均，塑造了吸毒者使用毒品的当地环境；以及(3)D-RCJ活动(可能还有SA方案)对不同种族/民族的吸毒者与毒品相关的艾滋病毒危险行为和卫生服务使用产生不同的影响。解释与毒品有关的艾滋病毒风险和卫生服务使用方面的种族/民族差异是NIDA的优先事项。然而，目前对SA计划和D-RCJ活动的衡量标准排除了研究这些干预措施是否会影响注射吸毒者中与药物相关的艾滋病毒危险行为、健康结果和服务使用的地理差异。这项拟议的探索性研究将通过分析现有数据达到3个目标：(A)构建基于地点、结构性和多维干预的SA计划和D-RCJ活动的新指标；以及(1b)应用这些措施来描述纽约市42个卫生区SA计划和D-RCJ活动随时间(1995-2006年)的变化。通过应用空间分析方法，我们将计算纽约市每个卫生区和年份获得注射器和SA计划的空间(总体和按计划类型)；以及与毒品有关的逮捕、监禁和警察监视的强度。(2)采用多水平方法探讨不同卫生地区和不同时间的这些措施的差异是否与吸毒者在不同地区和不同时间的毒品相关艾滋病毒危险行为和卫生服务使用方面的差异有关。(3)探索这些地区一级措施的差异是否会在注射吸毒者的种族/民族群体内部和之间造成与毒品有关的艾滋病毒危险行为和服务使用的差异。拟议的项目将为未来调查SA计划和D-RCJ活动如何在多个城市的注射吸毒者人群的广泛健康行为(例如，HIV性风险)、结果(例如，HIV传播)和服务使用(例如，进入药物治疗)中塑造社区层面的差异奠定基础。基于这些措施的研究可能为如何修改SA计划和D-RCJ活动以降低吸毒者、他们的性伴侣和邻居的发病率和死亡率提供重要的见解。在同一城市的不同社区，与毒品相关的艾滋病毒危险行为和不良健康后果的公共卫生相关性说明率各不相同。还没有研究探索注射器获取(SA)计划或与毒品相关的刑事司法(D-RCJ)活动是否会影响这种邻里层面的差异。拟议的项目将构建SA计划和D-RCJ活动的衡量标准，使我们能够探索这些计划和活动是否在一个城市的关键药物相关健康行为、结果和服务使用方面造成邻里层面的差异，并将实证测试美国一个城市(纽约市)SA计划和D-RCJ活动的变化是否与(1)吸毒者与毒品相关的艾滋病毒危险行为和医疗服务使用的社区层面的差异以及(2)这些结果的种族/民族差异有关。项目创建的SA计划和D-RCJ活动的衡量标准可以应用于其他城市，并可用于分析社区层面在注射者的广泛健康行为、结果和服务使用(例如，性危险行为、艾滋病毒或丙型肝炎传播、药物治疗进入)方面的差异。基于这些措施的研究可能为如何修改SA计划和D-RCJ活动以降低吸毒者、他们的性伴侣和邻居的发病率和死亡率提供重要的见解。考虑到SA计划对当地生活质量的负面影响，项目措施也可用于经验性地测试SA计划在社区的存在与当地犯罪率和其他不利社会后果之间的关系。

DESCRIPTION (provided by applicant): The likelihood that illicit drug users will engage in drug-related HIV risk behaviors or suffer adverse drug-related health outcomes varies considerably across neighborhoods. While an emerging line of research has investigated whether particular neighborhood-level characteristics (e.g., presence of dilapidated housing and social disorder) determines neighborhood-level variation in these drug-related behaviors and health outcomes, no research has yet studied whether syringe access (SA) programs or drug-related criminal justice (D-RCJ) activities contribute to neighborhood-level variations in drug-related behaviors and health outcomes among illicit drug users, including injection drug users (IDUs). This absence is striking: (1) SA programs and D-RCJ activities affect patterns of drug-related health behaviors, outcomes, and service use; (2) SA programs and D- RCJ activities are place-based, structural interventions: they are unevenly distributed across neighborhoods and shape the local context in which IDUs use drugs; and (3) D-RCJ activities (and possibly SA programs) exert different impacts on drug-related HIV risk behaviors and health service use among IDUs of different racial/ethnic groups. Explaining racial/ethnic variations in drug-related HIV risk and health service use is a NIDA priority. Current measures of SA programs and D-RCJ activities, however, preclude studying whether these interventions shape geographic variation in drug-related HIV risk behaviors, health outcomes and service use among IDUs. The proposed exploratory study will achieve 3 aims by analyzing existing data: to (1a) Construct new measures of SA programs and D-RCJ activities as place-based, structural, and multidimensional interventions; and (1b) Apply these measures to describe variations in SA programs and D- RCJ activities over time (1995-2006) across NYC's 42 health districts. By applying spatial analysis methods we will calculate, for each NYC health district and year, spatial access to syringes and to SA programs (overall and by program type); and intensity of drug-related arrest, incarceration, and police surveillance. (2) Use multilevel methods to explore whether variations in these measures across health districts and time are related to variations among IDUs in drug-related HIV risk behaviors and health service use across districts and time. (3) Explore if variations in these district-level measures create variations in drug-related HIV risk behaviors and service use, both within and between racial/ethnic groups of IDUs. The proposed project will lay the foundations for future investigations of the ways that SA programs and D-RCJ activities shape neighborhood- level variations in a wide range of health behaviors (e.g., HIV sexual risk), outcomes (e.g., HIV transmission), and service use (e.g., drug treatment entry) among IDU populations in multiple cities. Research based on these measures may provide important insight into how to modify SA programs and D-RCJ activities so as to reduce morbidity and mortality among drug users, their sex partners, and neighbors. Public Health Relevance Statement Rates of drug-related HIV risk behaviors and adverse drug-related health outcomes vary across neighborhoods in a city. No research has yet explored whether syringe access (SA) programs or drug-related criminal justice (D-RCJ) activities affect this neighborhood-level variation. The proposed project will construct measures of SA programs and D-RCJ activities that will allow us to explore whether these programs and activities create neighborhood-level variation in key drug-related health behaviors, outcomes, and service use in a city, and will empirically test whether changes in SA programs and D-RCJ activities in one US city (NYC) are associated with (1) neighborhood-level variation in drug injectors' drug-related HIV risk behaviors and health service use and (2) racial/ethnic variations in these outcomes. Project-created measures of SA programs and D-RCJ activities can be applied to other cities, and can be used to analyze neighborhood-level variations in a wide range of health behaviors, outcomes, and service use among injectors (e.g., sexual risk behaviors, HIV or HCV transmission, drug treatment entry). Research based on these measures may provide important insight into how to modify SA programs and D-RCJ activities so as to reduce morbidity and mortality among drug users, their sex partners, and neighbors. Given concerns that SA programs adversely affect local quality of life, project measures can also be used to empirically test the relationship between SA program presence in a neighborhood and local crime rates and other adverse social outcomes.