Community Vulnerability and Responses to Drug-User-Related HIV/AIDS

描述（由申请人提供）：这是一个竞争性的继续申请，用于社区脆弱性和对吸毒者相关艾滋病毒/艾滋病的反应研究，研究为什么美国大都市地区在吸毒者中对艾滋病毒/艾滋病的脆弱性及其反应方面随时间而变化，即，可能影响疫情的政策和计划。药物使用和艾滋病毒流行随着时间的推移而变化。在上一个资助期间，我们发现，从1992年到2002年，美国96个最大的大都市地区的注射毒品使用者（IDUs）的艾滋病毒流行率下降，从1992年到2000年，这些地区的IDUs人口流行率下降，但随后又开始上升。我们还表明，大都市地区在这些轨迹上各不相同，各种社会和政策力量塑造了IDU流行率，IDU流行率的种族差异，IDU中的艾滋病毒流行率，IDU中艾滋病流行率的种族差异，药物滥用治疗覆盖率，以及注射器交换的获得和覆盖率。不幸的是，我们最近的分析表明，注射吸毒者在青年（15 - 29岁）中的流行率已开始上升。此外，如其他人所示，艾滋病毒在一些大都市地区的非注射吸毒者（海洛因、可卡因、快克、安非他明或甲基安非他明的非注射吸毒者）中广泛传播。这些变化是在经济最近从缓慢下降转为迅速下降的背景下发生的，这种转变将导致很难维持，更不用说扩大对吸毒者的服务。因此，这一拟议延续的具体目标是：1。描述1992 - 2012年美国96个最大城市地区的趋势，（a）关键流行病学结果（注射吸毒者和非注射吸毒者的人口流行率，特别是其在青年中的流行率;以及（B）实施循证的药物相关干预措施（c）与毒品有关的非循证干预措施（监禁和逮捕吸毒者）。2.要了解宏观社会背景（例如，经济变化、社会融合、种族居住隔离）和流行病学需要影响干预;干预和宏观社会背景如何共同影响流行病学背景;一些干预（例如，逮捕、监禁）影响他人（例如，注射器交换覆盖率）;以及一些流行病学结果（例如，年轻注射吸毒者的流行率）影响其他人（例如，艾滋病毒流行率）。3.开发一个集成的理论，使用基于代理的建模，这些过程如何相互作用，从而在给定的社会背景下，各种干预组合的影响可能是什么。4.向公共卫生机构传播估计数、结果和理论认识，并继续就如何应对提供建议。 公共卫生相关性：该项目将估计21年期间（1992 - 2012年）96个大都市地区注射和非注射吸毒、注射吸毒者中艾滋病毒、艾滋病和艾滋病死亡率以及吸毒者中与毒品和艾滋病毒有关的干预措施的变化。我们将研究这些流行病和干预措施如何相互影响，以及经济和社会条件等宏观背景因素如何塑造它们。我们将确定出现严重吸毒、艾滋病毒或艾滋病流行的大都市地区，并向州和地方卫生部门以及药品机构提供有关可能减少这些流行病的政策和方案的最佳信息。我们的研究结果还将帮助国家公共卫生机构，包括CDC和SAMHSA，以及其他研究人员，计划一系列基于证据的计划和政策，以减少导致高风险药物使用和相关艾滋病毒和艾滋病流行的力量。

DESCRIPTION (provided by applicant): This is a competing continuation application for the Community Vulnerability and Responses to Drug-User- Related HIV/AIDS study of why large US metropolitan areas vary over time in their vulnerability to HIV/AIDS among drug users and in their responses-i.e., in policies and programs that may affect the epidemic. Drug use and HIV epidemics change over time. In the last funding period, we showed that HIV prevalence in the 96 largest US metropolitan areas declined among injection drug users (IDUs) from 1992 to 2002, and that the population prevalence of IDUs declined in these areas from 1992 to 2000, but then began to rise again. We also showed that metropolitan areas varied in these trajectories, and that a variety of social and policy forces shaped IDU prevalence, racial disparities in IDU prevalence, HIV prevalence among IDUs, racial disparities in AIDS prevalence among IDUs, drug abuse treatment coverage, and syringe exchange access and coverage. Ominously, our recent analyses indicate that the prevalence of IDUs among youth (aged 15 - 29) has begun to rise. Further, as others have shown, HIV has spread widely among NIDUs (non-injecting users of heroin, cocaine, crack, amphetamines or methamphetamine) in some metropolitan areas. These changes are occurring against the backdrop of an economy that has recently shifted from slow to rapid decline, a shift that will lead to great difficulty in maintaining, let alone expanding, services for drug users. Therefore, the Specific Aims of this proposed continuation are: 1. To describe trends, in the 96 largest US metropolitan areas from 1992 - 2012, in (a) critical epidemiologic outcomes (population prevalence of IDUs and NIDUs, and particularly their prevalence among youth; and, among IDUs, HIV prevalence, late-diagnosis HIV cases, and AIDS incidence and mortality) as well as in (b) the implementation of evidence-based drug- related interventions (drug abuse treatment, syringe exchange, HIV counseling and testing) and (c) non- evidence-based drug-related interventions (incarceration and arrests of drug users). 2. To understand how macro-social contexts (e.g., economic changes, social integration, racial residential segregation) and epidemiologic need affect interventions; how interventions and macro-social contexts together affect epidemiologic contexts; how some interventions (e.g., arrests, incarceration) affect others (e.g., syringe exchange coverage); and how some epidemiologic outcomes (e.g., prevalence of young IDUs) affect others (e.g., HIV prevalence). 3. To develop an integrated theory, using agent based modeling, of how these processes interact and thus what the impacts of various intervention mixes are likely to be in given social contexts. 4. To disseminate estimates, results and theoretical understandings to public health agencies and continue to advise them on how they might respond. PUBLIC HEALTH RELEVANCE: This project will estimate changes in injection and non-injection drug use, in HIV, AIDS and AIDS mortality rates among injection drug users, and in drug- and HIV-related interventions among drug users, in 96 large metropolitan areas over a 21-year period (1992 - 2012). We will investigate how these epidemics and interventions affect one another, and how macro-contextual factors like economic and social conditions shape them both. We will identify metropolitan areas in which serious drug use, HIV or AIDS epidemics are emerging, and offer state and local health departments and drug agencies the best information available on policies and programs that might reduce these epidemics. Our findings will also help national public health agencies, including the CDC and SAMHSA, and other researchers, plan a mixture of evidence-based programs and policies to reduce the forces that lead to high-risk drug use and the associated HIV and AIDS epidemics.