Exploratory Research on Late Initiation of Drug Injection

我们提出了一项为期3年的定性探索性研究“晚启动”（30岁或以后开始注射毒品的人）和“典型启动”（30岁之前开始注射的人），以更好地了解情况，动机，社会环境和HIV，HCV和HBV的风险与注射开始后的生活。据估计，美国有300万注射毒品使用者（IDUs）。非法药物使用的许多有害健康后果，包括艾滋病毒、丙型肝炎病毒和乙型肝炎病毒，以及软组织感染和过量，都与注射行为有关。15%至19%的注射吸毒者在30岁后开始注射毒品。很少有人知道晚些时候开始与“典型”开始（在30岁之前开始）有什么不同。我们建议研究药物，个人特征和社会环境方面如何影响30岁及以上的成年人过渡到药物注射。虽然有十几篇关于药物注射开始的论文，但大多数研究都集中在年轻注射者和第一次注射事件的具体情况上，并且没有系统地考虑给药途径如何与药物使用轨迹，生活事件以及累积的健康，社会和心理社会脆弱性（例如，艾滋病毒/艾滋病和其他疾病、多次监禁、创伤事件、代际贫穷）。这一知识差距是巨大的，因为较晚开始的人可能需要与青少年和年轻人不同的艾滋病毒和药物滥用预防和治疗方法。拟议的定性研究的主要目标是了解和比较晚启动典型的启动，并提供一个“厚描述”之间的药物使用，生活事件，艾滋病毒的风险和感染，社会和物理环境，并开始药物注射的交叉点。我们的建议使用Zinberg的经典框架药物，设置和设置（DSS）和生命历程理论（LCT）来指导这项探索性研究的目标，研究问题和分析。我们确立了以下目标。目的1：探索使用LCT结构的晚期启动者中药物和药物注射（DRUG）的属性。目标二：描述个体特征，包括HIV状态和对HIV/AIDS风险的认知、药物使用史和与使用LCT结构的典型启动者相比的晚期启动者的关键生活事件（SET）。目标3：探索人际关系，社会和结构环境（包括艾滋病毒/艾滋病和其他传染病在社区的流行情况-设置）的晚启动相比，典型的启动使用LCT结构。为了实现这些目标，我们建议进行一项定性的探索性研究，比较80晚启动和80个典型的启动。参加者将是艾滋病毒阴性和艾滋病毒阳性的活跃注射吸毒者，他们是使用有针对性的抽样方法从社区环境中招募的。我们将使用扎根理论的方法和生活事件的方法来深入探讨有关的概念，药物，SET和设置，影响晚开始注射毒品使用。为了捕捉注射吸毒者和环境的多样性，我们将在洛杉矶和旧金山弗朗西斯科招募注射吸毒者，这两个城市在IOU人口统计学、药物使用偏好、注射吸毒者中HIV/AIDS的发病率和流行率以及其他社区和环境影响方面存在重要差异。探索DSS晚启动将有助于确定预防注射吸毒，注射相关的风险，艾滋病毒/艾滋病，以及其他健康和社会后果的影响因素。

We propose a 3-year, qualitative exploratory study of 'late initiates' {individuals who began injecting drugs at age 30 or later) and 'typical initiates' {those who initiate injection prior to 30) in order to better understand the circumstances, motivations, social environments and HIV, HCV, and HBV risk associated with injection initiation later in life. There are an estimated 3 million injection drug users {IDUs) in the US. Many of the detrimental health consequences of illicit drug use, including HIV, HCV, and HBV, as well as soft-tissue infections, and overdose, are related to the act of injection. Between 15% and 19% of IDUs initiated drug injection after turning 30 years old. Little is known about how late initiates differ from "typical" initiates {initiating before age 30). We propose to examine how aspects of drugs, individual characteristics, and social environments affect transition to drug injection among adults 30 years of age and older. While there are more than a dozen published papers on initiation of drug injection, most studies have focused on young injectors and the specific circumstances of the first injection episode, and do not systematically consider how route of administration might intersect with drug use trajectories, life events, and accumulated health, social, and psychosocial vulnerabilities {e.g., HIV/AIDS and other conditions, multiple incarcerations, traumatic events, intergenerational poverty). This gap in knowledge is significant since late initiates are likely to need different approaches to HIV and substance abuse prevention and treatment than adolescents and young adults. The primary goals of the proposed qualitative study are to understand and compare late initiates to typical initiates and to provide a "thick description" of the intersections amongst drug use, life events, HIV risk and infection, social and physical environments, and initiation of drug injection. Our proposal uses Zinberg's classic framework of Drug, Set, and Setting {DSS) and lifcourse theory {LCT) to guide the aims, research questions, and analyses of this exploratory study. We have established the following aims. Aim 1: To explore attributes of drugs and drug injection (DRUG) among late initiates using LCT constructs. Aim 2: To describe individual characteristics, including HIV status and perceptions of HIV/AIDS risks, drug use histories, and key life events (SET) of late initiates as compared to typical initiates using LCT constructs. Aim 3: To explore the interpersonal, social, and structural environments (including the prevalence of HIV/AIDS and other infectious diseases in the community- SETTING) of late initiates compared to typical initiates using LCT constructs. To accomplish these aims, we propose to conduct a qualitative, exploratory study comparing 80 late initiates and 80 typical initiates. Participants will be HIV negative and HIV positive, active IDUs recruited from community settings using targeted sampling methods. We will use the grounded theory method and life event approaches to explore in-depth the concepts related to DRUG, SET, and SETTING that influence late initiation to injection drug use. To capture a diversity of IDUs and settings, we will recruit IDUs in Los Angeles and San Francisco, two cities that have important differences in IOU demographics, drug use preferences, the incidence and prevalence of HIV/AIDS among IDUs, and other community and environmental influences. Exploring DSS among late initiates will help to identify influential factors for the prevention of injection drug use, injection-related risks for HIV/AIDS, and other health and social consequences.