Environmental Factors in HIV Transmission among Suburban IDUs

描述(由申请人提供)：最近的证据表明，郊区居民中注射毒品的使用正在增加。很少有研究关注这一趋势，也没有考虑到其经济、社会和医学后果。为了缩小这一差距，我们建议使用响应者驱动抽样(RDS)来识别、招募和研究居住在康涅狄格州郊区的有效注射者样本。RDS之所以被选中，是因为它在识别隐藏人群中的个人并允许对样本进行统计分析方面具有优势。我们提交这份申请是为了响应PAR-06-114《环境、行为和艾滋病毒/艾滋病联系途径的研究》。我们不仅将重点放在一个被忽视的环境--郊区，而且还将进一步关注在两个不同环境中注射的郊区注射器。初步研究表明，有一些人主要在他们居住的郊区城镇注射，还有一些人在他们获得毒品的城市地区注射。我们的研究围绕以下假设展开：(1)注射毒品使用模式；(2)艾滋病毒、乙肝和丙型肝炎感染的知识、风险和流行率；(3)社会人口稳定性；(4)减少注射负面后果的服务使用和障碍。我们的研究将招募居住在郊区的600名活跃的注射吸毒者作为样本。样本将通过结构化访谈、血清学和深入的生活史进行研究。将对样本进行纵向跟踪，以确定郊区或城市注射模式是否稳定，并确定与注射环境变化和注射器传播病毒感染风险有关的因素。我们的研究旨在回答以下问题：(1)样本对潜在人群的代表性有多大；(2)两组郊区注射者在疾病知识、风险和流行率方面是否存在差异；(3)个体、群体和环境水平的变量可以预测多少艾滋病毒、乙肝病毒和丙型肝炎病毒的流行率；(4)郊区注射者在地理上是如何聚集的，这是否会影响疾病流行率；(5)与刑事司法系统的互动如何影响药物使用和高风险注射做法，(6)哪些因素与逮捕和监禁有关；(7)注射者如何使用药物治疗和疾病预防计划，以及他们认为更多使用这些服务的障碍是什么。为了实现这项研究的目标，我们组建了一支经验丰富的多学科团队，他们可以收集和分析定量、定性和血清学数据，并通过学术和公共卫生渠道向科学界传播研究结果，并通过我们的艾滋病跨学科研究中心向服务社区传播研究结果。

DESCRIPTION (provided by applicant): Recent evidence suggests that injection drug use is increasing among suburban residents. Little research has focused on this trend, and the economic, social, and medical consequences have not been considered. To close this gap, we are proposing to identify, recruit, and study a valid sample of injectors who reside in Connecticut suburbs using respondent driven sampling (RDS). RDS was selected because of its strengths in identifying individuals from hidden populations and allowing statistical analysis of the sample. We are submitting this application in response to PAR-06-114, "Research on Pathways Linking Environments, Behaviors and HIV/AIDS". Not only will be focusing on an environment - the suburbs - that has been neglected, but we will further focus on suburban injectors who inject in two distinct environments. Preliminary studies revealed that there are those who inject predominantly in the suburban town in which they reside and those who inject in urban areas where they obtain their drugs. We are building our study around the hypothesis that the two environments result in differences in (1) injection drug use patterns; (2) knowledge of, risk for, and prevalence of HIV, hepatitis B, and hepatitis C infections; (3) sociodemographic stability; and (4) the use of and barriers to services that reduce the negative consequences of injection. Our study will recruit a sample of 600 active injection drug users who reside in the suburbs. The sample will be studied through structured interviews, serology, and in-depth life histories. The sample will be followed longitudinally to ascertain whether the pattern of suburban or urban injection is stable and to identify factors associated with changes in injection environments and in risk for syringe-borne viral infection. Our study is designed able to answer questions including (1) how representative the sample is of the underlying population, (2) whether two groups of suburban injectors who differ based on where they inject differ in terms of disease knowledge, risk, and prevalences, (3) how much of the prevalence of HIV, HBV, and HCV can be predicted by individual, group, and environmental level variables, (4) how suburban injectors are geographically clustered and whether this affects disease prevalence, (5) how interaction with the criminal justice system influences drug use and risky injection practices, (6) which factors are associated with arrest and incarceration and (7) how injectors use drug treatment and disease prevention programs and what they perceive as the barriers to larger use of these services. To meet the objectives of this study, we have assembled an experienced, multidisciplinary team that can collect and analyze the quantitative, qualitative, and serological data and disseminate research findings to the scientific community through scholarly and public health channels and to the service community through our Center for Interdisciplinary Research on AIDS.