Community Vulnerability and Responses to IDU-Related HIV

描述（由申请人提供）：在这一竞争性延续中，我们将对96个大都市地区进行纵向研究（1993-2007年），以研究药物注射者人口流行率变化的趋势和预测因素，注射者中的HIV流行率，以及相关的预防计划。在该项目的第一阶段，我们制定了估计大都市地区注射吸毒人口密度和艾滋病毒流行率的方法。我们发现，20世纪90年代，包括巴尔的摩和湖城的许多地区的人均注射毒品使用量都有所增加。在巴尔的摩和其他一些地区，注射吸毒者中的艾滋病毒流行率有所上升。在许多大都市地区，注射毒品者中的毒品注射率和艾滋病毒感染率都有所下降。地方艾滋病毒预防方案覆盖吸毒者的程度也有很大差异：3个大都市地区为20%或更多的吸毒者提供治疗，而13个地区的治疗率不到5%。艾滋病毒咨询和检测率也有很大差异。在横断面分析中，我们发现，地方政府的预算决策，社会和经济因素，药物滥用干预措施与注射吸毒者人均，注射吸毒者中的艾滋病毒感染率，以及各种方案的存在和规模，以防止注射吸毒者中的艾滋病毒。我们将建立在我们现有的数据，并构建一个数据库，为这96个大都市地区包含从1993年至2007年的人均注射毒品的年度估计;艾滋病毒感染率，艾滋病发病率和艾滋病死亡率注射毒品;方案的可用性和规模;社会经济条件和政府预算拨款。我们将（1）描述预防计划和流行病学随时间变化的模式。我们将使用纵向分析方法来研究（2）不断变化的社会经济条件、流行病学需求、预算限制和选择以及政策选择如何与随后的艾滋病预防规划相关联;以及（3）所有这些变量如何与（a）人均注射毒品者，（B）注射毒品者中的艾滋病毒流行率和艾滋病，（c）针对注射毒品者的药物滥用治疗和其他方案，以及（d）适当指标中的种族/族裔差异。我们将利用这些分析来发展一个良好的理论化的科学理解的力量，塑造大都市地区艾滋病毒/艾滋病的流行，吸毒注射者的人均比率，和预防计划。由此产生的科学知识库可以帮助制定方案和政策，以避免流行病，并在必要时控制流行病。

DESCRIPTION (provided by applicant): In this competing continuation, we will conduct a longitudinal study (1993-2007) of 96 large metropolitan areas to study trends and predictors of changes in the population prevalence of drug injectors, HIV) prevalence among injectors, and related prevention programs. In stage one of this project, we developed ways to estimate the population density of injection drug use and HIV prevalence rates in metropolitan areas. We showed that per capita injection drug use increased during the 1990s in many localities, including Baltimore and Salt Lake City. HIV prevalence rates among drug injectors increased in Baltimore and some other areas. In many metropolitan areas, drug injection and HIV rates among injectors declined. The extent to which local HIV prevention programs reached drug injectors also varied widely: 3 metropolitan areas provided treatment to 20% or more of their injectors, while 13 areas reached less than 5%. HIV counseling and testing rates also varied widely. In cross-sectional analyses, we showed that local government budgetary decisions, social and economic factors, and drug abuse interventions were related to injection drug users per capita, HIV revalence among drug injectors, and the presence and size of various programs to prevent HIV among drug injectors. We will build upon our existing data and construct a database for these 96 metropolitan areas containing annual estimates from 1993 - 2007 of drug injectors per capita; HIV prevalence, incident AIDS cases and AIDS mortality among drug injectors; program availability and size; socioeconomic conditions, and government budgetary allocations. We will (1) describe patterns of change over time in prevention programs and epidemiology. We will use longitudinal analysis methods to study (2) how changing socioeconomic conditions, epidemiologic need, budgetary constraints and choices, and policy choices are related to subsequent HIV prevention programming; and (3) how all these variables are related to later changes in (a) drug injectors per capita, (b) HIV prevalence and AIDS among drug injectors, (c) drug abuse treatment and other programs for drug injectors, and (d) racial/ethnic disparities in appropriate indicators. We will use these analyses to develop a well-theorized scientific understanding of forces that shape metropolitan area HIV/AIDS epidemics, rates of drug injectors per capita, and prevention programs. The resulting scientific knowledge base can help develop programs and policies so as to avoid epidemics and, if needed, control them.