Staying Safe: Training IDUs in Strategies to Avoid HIV and HCV Infection

描述（由申请人提供）：我们建议根据长期注射吸毒者的策略和实践开发一种创新的保持安全干预措施，这些人不仅没有感染艾滋病毒，而且没有感染丙型肝炎（HCV）。本研究将测试这种干预的有效性。仅在美国，注射吸毒就占每年新增艾滋病毒感染的13%（疾病预防控制中心2007年）。在全球范围内，1260万注射吸毒者占新感染艾滋病毒的10%。因此，迫切需要减少这类感染的新方法。我们的“保持安全”研究小组提出了基于研究的假设，关于如何使用一种新的设计来减少感染：积极偏差控制-病例生活史方法（Friedman et al. 2008）。“保持安全”研究研究了纽约市少数长期注射吸毒者如何制定策略，既不感染艾滋病毒，也不感染丙型肝炎（HCV）。基于这些发现，我们提出了一项探索性的R21课程，以指导注射吸毒者如何制定和实施长期战略，以避免高风险环境（例如射击场）和风险环境（例如海洛因戒断），以及如何避免风险行为，即使他们发现自己处于高风险环境或环境中（例如携带干净的针头到射击场）。本提案的具体目标是：(1)制定一个有两个主要目标的安全干预课程：加强注射吸毒者预防注射或性艾滋病毒和丙型肝炎病毒感染（如果艾滋病毒和/或丙型肝炎病毒阴性）或艾滋病毒和/或丙型肝炎病毒注射或性传播给他人（如果感染）的能力；(2)根据新制定的“保持安全课程”对干预措施进行试点测试，审查其可接受性、可行性和安全性，并收集干预措施有效性的初步证据。在社会学习理论（Bandura, 1986）的指导下，保持安全干预将针对以下自我改变机制：增加对风险环境、环境和行为的信息和意识；教授从我们的初步研究中直接产生的新的生成能力；也就是说，降低风险的计划和解决问题的能力；注意社会网络在降低风险实践和维持行为改变中的作用；通过制定现实的长期预防目标，提高实施新的长期预防措施和策略的动机，并提高行为改变的自我效能。公共卫生相关性：声明注射吸毒仍然是全世界艾滋病毒和丙型肝炎病毒感染的主要危险因素。需要采取新的方法来减少这类感染。我们建议根据长期注射吸毒者的策略和做法制定一种新的安全干预措施，这些人不仅没有感染艾滋病毒，而且没有感染丙型肝炎（HCV）。本研究将测试这种干预的有效性。

DESCRIPTION (provided by applicant): We propose to develop an innovative Staying Safe Intervention based on the strategies and practices of long term IDUs who have managed to remain uninfected not only with HIV but also with Hepatitis C (HCV). This study will test the efficacy of such an intervention. In the USA alone, injection drug use accounts for 13% of new yearly HIV infections (CDC 2007). Worldwide, 12.6 million injection drug users internationally account for 10% of new HIV infections. Therefore, new approaches to reducing such infections are urgently needed. Our Staying Safe research team has developed research-based hypotheses about how to reduce infections using a novel design: The Positive Deviance Control-Case Life History method (Friedman et al. 2008). Staying Safe research studied how a minority of long-term IDUs in New York City develop strategies to remain uninfected not only with HIV but also with Hepatitis C (HCV). Based on these findings, we propose an exploratory R21 to develop a curriculum for teaching IDUs how to develop and implement long-term strategies to avoid high-risk contexts (e.g. shooting galleries) and circumstances of risk (e.g. heroin withdrawal) as well as how to avoid risk behaviors should they nonetheless find themselves in high-risk contexts or circumstances (e.g. carrying clean needles to shooting galleries). The specific aims of this proposal are to (1) develop a Staying Safe intervention curriculum with two main objectives: enhancing IDUs' capabilities to prevent injection or sexual HIV and HCV infection (if HIV and/or HCV negative) or injection or sexual transmission of HIV and/or HCV to others (if infected) and (2) pilot test an intervention based on the newly developed Staying Safe Curriculum, examining its acceptability, feasibility, and safety, and gathering preliminary evidence of the intervention's efficacy. Guided by social learning theory (Bandura, 1986) the Staying Safe Intervention will target the following self- change mechanisms: increase information about and awareness of risk environments, circumstances, and behaviors; teach new generative capabilities that have emerged directly from our preliminary studies; that is, skills, such as planning and problem solving to reduce risk; attend to the role of social networks in risk reduction practices and maintenance of behavior change; and increase motivation for implementing new long term preventive practices and strategies through the development of realistic long term preventive goals, and enhancing self efficacy for behavior change. PUBLIC HEALTH RELEVANCE: Statement Injection drug use continues to be a major risk factor for HIV and HCV infections worldwide. New approaches to reducing such infections are needed. We propose to develop a new Staying Safe Intervention based on the strategies and practices of long term IDUs who have managed to remain uninfected not only with HIV but also with Hepatitis C (HCV). This study will test the efficacy of such an intervention.