Epidemiology of HIV and Hepatitis C Among Injecting Drug Users in Tijuana

描述（由申请人提供）：该项目的总体目标是描述墨西哥蒂华纳注射吸毒者（IDUs）中艾滋病毒和丙型肝炎病毒的流行病学特征。最近的数据表明，在墨西哥-美国西北边境的注射吸毒者中，艾滋病毒的亚流行是动态的，注射吸毒现在是一个主要的公共卫生问题。本提案的目的是：1)基于失配检测确定蒂华纳注射吸毒者中HIV、HCV和梅毒的患病率，并估计HIV的发病率；确定…的程度。哪些可能改变的个人、社会和环境因素影响了蒂华纳注射吸毒者的以下结果：i)流行的艾滋病毒和丙型肝炎病毒以及事件艾滋病毒感染；Ii)血源性感染的危险行为（例如，直接和间接共用注射器、射击场出席）；（三）在通过药店合法获得注射器的情况下，获取和使用无菌注射器和注射用具的障碍。感兴趣的个人水平因素包括对艾滋病毒和丙型肝炎病毒血清状态的了解，最近开始注射和使用特定注射药物组合（例如，海洛因和甲基苯丙胺）和配方（例如，海洛因焦油和粉末）；社会因素包括移民和个人网络特征；环境因素包括地理空间因素（例如，与边境的距离、过境的频率、射击场的密度、药店和药物治疗方案）以及执法经验。3)探讨提华纳以下利益相关者对减少毒品相关伤害的干预措施的社会接受程度。为了实现目标1和目标2，将采用应答者驱动抽样方法招募2000名在过去6个月内至少注射过一次的注射吸毒者，这将有助于对艾滋病毒和丙型肝炎病毒的流行情况和相关风险行为进行无偏估计。面对面访谈将收集社会人口统计和行为数据。为了评估地理空间因素，我们将使用手持式全球定位系统设备来绘制射击场、药店和药物治疗项目的十字街道位置。为了实现目标3，我们将对三种类型的关键线人（例如，系统、互动者和街道一级的关键线人）进行深入访谈。尽管墨西哥被认为是艾滋病毒/艾滋病流行率低、疫情集中的国家，但人们认为预防的机会之窗正在迅速关闭，因为与注射药物有关的艾滋病毒流行病往往是爆炸性的，并可能迅速蔓延。本研究将为在最大的墨西哥-美国合作项目之一中发展文化适宜的干预措施提供信息。这对两国的政策制定和项目规划都有影响。

DESCRIPTION (provided by applicant): The overall goal of this project is to characterize the epidemiology of HIV and HCV among injecting drug users (IDUs) in Tijuana, Mexico. Recent data suggest a dynamic HIV sub-epidemic among IDUs on the northwestern Mexico-US border where injection drug use is now a major public health problem. The aims of this proposal are: 1) To determine HIV, HCV and syphilis prevalence and estimate HIV incidence based on the detuned assay among IDUs in Tijuana; 2) To determine the extent to. which potentially modifiable individual, social and environmental factors influence the following outcomes among IDUs in Tijuana: i) prevalent HIV and HCV and incident HIV infections; ii) risk behaviors for blood borne infections (e.g., direct and indirect syringe sharing, shooting gallery attendance); iii) barriers to access and use of sterile syringes and injection paraphernalia within the context of legal syringe access through pharmacies. Individual level factors of interest include knowledge of HIV and HCV serostatus, recent onset injection and use of specific injection drug combinations (e.g., heroin and methamphetamine) and formulations (e.g., heroin tar versus powder); Social factors include emigration and personal network characteristics; Environmental factors include geospatial factors (e.g., distance from the border, frequency of border crossings, density of shooting galleries, pharmacies and drug treatment programs), and experiences with law enforcement. 3) To examine the social acceptability of interventions to reduce drug-related harm among the following stakeholders in Tijuana. To meet Aims 1 and 2, 2000 IDUs who have injected at least once in the prior 6 months will be recruited using respondent driven sampling, which will facilitate an unbiased estimate of HIV and HCV prevalence and associated risk behaviors. Face-to-face interviews will collect sociodemographic and behavioral data. To assess geospatial factors, we will use hand-held global positioning system devices to map cross-street locations of shooting galleries, pharmacies and drug treatment programs. To meet Aim 3,we will conduct in-depth interviews with three types of key informants (e.g., systems, interactor and street-level key informants). Although Mexico is considered a country of low HIV/AIDS prevalence with a concentrated epidemic, the window of opportunity for prevention is believed to be closing rapidly since IDU-associated HIV epidemics are often explosive and can quickly become generalized. This study will inform the development of culturally-appropriate interventions in one of the largest Mexican-U.S. cities, which has implications for policy making and program planning for both countries.