HIV Risk, Drug Use, Social Networks: Homeless Persons Transitioned to Housing

描述(由申请人提供)：我们利用社会生态模型来了解长期无家可归者，主要是非洲裔美国人，过渡到永久支持性住房(PSH)的艾滋病毒风险和预防行为的纵向变化。无家可归者面临着不成比例的艾滋病毒和吸毒风险。PSH计划作为这一弱势群体的综合保健服务中心，但几乎没有研究了解居民中的艾滋病毒风险和预防，或在PSH内提供艾滋病毒预防服务，除了专门为艾滋病毒/艾滋病患者提供的服务。一些证据表明，随着时间的推移，过渡到住房可能会增加而不是减少危险行为，尽管缺乏澄清这些复杂性的研究。具体目标如下：1)研究过渡到PSH与艾滋病毒风险和预防行为随时间的变化如何相关；2)研究向PSH过渡如何与PSH居民的社会网络变化相关联，以及网络如何与随时间变化的艾滋病毒风险和预防行为相关联；3)检查向PSH过渡如何与PSH居民的药物使用和精神健康症状的变化相关，以及这些个人特征的变化如何与随时间推移的HIV风险和预防行为相关联；4)确定PSH提供者是否以及如何促进艾滋病毒预防，并了解可能影响居民艾滋病毒风险的政策和程序；5)综合目标1-4的调查结果，为降低艾滋病毒传播风险和加强为PSH居民提供艾滋病毒预防服务的具体战略提供信息。目标1-3将通过连续录取PSH的结构化面试(基线、3、6、12个月)来解决(12个月时N=405)。目标4将通过个别访谈PSH项目的监督人员(N=30)和焦点小组与一线工作人员(N=100)，以及对PSH居民进行人种学阴影(N=30)来解决。AIM 5将通过50个PSH提供者和50名居民的焦点小组综合AIMS 1-4的结果。

DESCRIPTION (provided by applicant): We utilize a social ecological model to understand longitudinal changes in HIV risk and prevention behaviors among chronically homeless, predominantly African American men and women who transition into permanent supportive housing (PSH). Homeless persons face disproportionate risk of HIV and drug use. PSH is intended as the locus of integrated health services for this vulnerable population, yet there has been almost no research to understand HIV risk and prevention among residents, or the provision of HIV prevention services within PSH, except specifically for people living with HIV/AIDS. Some evidence suggests that transitioning to housing could increase rather than decrease risk behaviors over time, although research to clarify these complexities is absent. Specific Aims are as follows: 1) To examine how transition to PSH is associated with HIV risk and prevention behaviors over time; 2) To examine how transition to PSH is associated with changes in social networks of PSH residents, and how networks are associated with changes in HIV risk and prevention behaviors over time; 3) To examine how transition to PSH is associated with changes in drug use and mental health symptoms among PSH residents, and how changes in these individual characteristics are associated with HIV risk and prevention behaviors over time; 4) To determine whether and how PSH providers promote HIV prevention, and to understand policies and procedures that may impact HIV risk among residents; 5) To synthesize findings from Aims 1- 4 to inform specific strategies to reduce risk of HIV transmission and to enhance HIV prevention services for residents in PSH. Aims 1-3 will be addressed through structured interviews (baseline, 3, 6, 12 months) with consecutive admissions to PSH (N=405 at 12 months). Aim 4 will be addressed through individual interviews with supervisory staff (N=30) and focus groups with front line staff (N=100) of PSH programs, and ethnographic shadowing of PSH residents (N=30). Aim 5 will synthesize findings of Aims 1-4 through focus groups with 50 PSH providers and 50 residents.