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

该项目的总体目标是确定注射毒品中艾滋病毒和丙型肝炎病毒的流行病学特征。 墨西哥提华纳的用户(IDU)。最近的数据表明，在吸毒者中存在动态的艾滋病毒亚流行 墨西哥西北部-美国边境注射吸毒现在是一个主要的公共卫生问题。的目标是 这项建议是：1)确定艾滋病毒、丙型肝炎病毒和梅毒的流行率，并根据以下数据估计艾滋病毒发病率 提华纳注射吸毒者的失谐检测；2)确定感染的程度。它可能是可修改的 个人、社会和环境因素影响提华纳注射吸毒者的下列结果：i) 流行的艾滋病毒和丙型肝炎病毒和偶发的艾滋病毒感染；二)血液传播感染的危险行为(例如，直接 和间接共用注射器、观看射击场)；三)获取和使用无菌注射器的障碍 以及通过药房合法获取注射器范围内的注射用具。个人层面 感兴趣的因素包括艾滋病毒和丙型肝炎病毒血清状态的知识，最近发病的注射和使用特定的 注射毒品组合(如海洛因和甲基苯丙胺)和配方(如海洛因焦油与 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，距边界的距离、越境频率、射击密度 美术馆、药店和药物治疗项目)，以及执法经验。3)审查 年以下利益攸关方减少毒品相关危害的干预措施的社会可接受性 提华纳。为了达到目标1和目标2，在过去6个月内至少注射一次的2000名注射吸毒者将被 使用受访者驱动的抽样进行招募，这将有助于对艾滋病毒和丙型肝炎病毒的公正估计 患病率和相关危险行为。面对面的采访将收集社会人口和 行为数据。为了评估地理空间因素，我们将使用手持全球定位系统设备来 绘制射击画廊、药店和药物治疗项目的交叉街道位置地图。为了达到目标3， 我们将深入采访三类主要线人(例如，系统、互动者和街道- 级别关键告密者)。尽管墨西哥被认为是艾滋病毒/艾滋病流行率较低的国家，但 随着疫情的集中，预防的机会之窗被认为正在迅速关闭，因为IDU- 相关的艾滋病毒流行往往是爆炸性的，并可能很快蔓延开来。这项研究将告诉我们 在墨西哥-美国最大的城市之一发展适合文化的干预措施，它已经 对两国的政策制定和项目规划的影响。

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.