Risk Factors for HIV/AIDS in Drug Users

描述（由申请人提供）：风险因素项目研究了纽约市自1978年以来（使用储存的血清）注射吸毒者（IDUs）中非常大的艾滋病毒流行情况，以及自1995年以来非注射海洛因和可卡因吸毒者（NIDUs）中非常大的艾滋病毒流行情况。在我们目前的研究中，我们已经证明了注射吸毒者中艾滋病毒传播的急剧减少，但也证明了注射吸毒者中艾滋病毒传播的大幅增加。（在过去十年中，纽约市nidu的艾滋病毒感染率翻了一番）。单纯疱疹病毒-2 （HSV-2）与HIV传播密切相关，我们已经确定HSV-2的流行是纽约市nidu中HIV传播的主要因素。本研究的具体目的包括：1)监测纽约市NIDUs和IDUs中HIV流行持续演变中的风险行为、HIV流行、发病率和服务利用情况。2)量化纽约市海洛因和可卡因使用者中HIV与HSV-2感染之间的长期人群水平关系，包括检验HSV-2与HIV之间的关联强度随时间增加的假设。最近的干预研究大大增加了了解2型单纯疱疹病毒/艾滋病毒关系的需要。3)评价纽约市卫生局安全套社会营销活动对纽约市注射吸毒者和非注射吸毒者的性危险行为和HIV和HSV-2感染的影响。纽约市注射吸毒者中与性行为和注射相关的HIV传播监测模式。纽约市的非注射吸毒者和注射吸毒者之间有许多联系。NIDUs和IDUs最好被视为纽约市海洛因和可卡因使用者群体中的关联群体。要彻底了解注射吸毒者之间的性传播，需要了解城市中注射吸毒者之间的注射和性传播。5)评估非注射吸毒者和注射吸毒者之间艾滋病毒感染的种族/民族差异的新模式。6)干预发展。这些目标将通过我们对非注射吸毒者和进入贝斯以色列药物治疗项目的注射吸毒者的继续研究来实现。这项拟议的研究将是第一个对大量注射吸毒者中艾滋病毒随时间传播的研究，第一个对注射吸毒者中HVS-2与艾滋病毒随时间变化关系的评估，以及第一个对大规模安全套社会营销活动对注射吸毒者和注射吸毒者性风险行为影响的评估。公共卫生相关性：艾滋病毒在非注射吸毒者中的性传播已成为美国一个主要的公共卫生问题。这项研究将对美国nidu中最大的HIV流行产生深入的了解。

DESCRIPTION (provided by applicant): The Risk Factors project has studied the very large HIV epidemic among injecting drug users (IDUs) in New York City from 1978 (using stored sera) and the very large HIV epidemic among non-injecting heroin and cocaine drug users (NIDUs) since 1995. In our current research, we have demonstrated a dramatic reduction in HIV transmission among IDUs, but also a substantial increase in HIV among NIDUS. (HIV prevalence has doubled among NIDUs in NYC over the last decade). Herpes simplex virus-2 (HSV-2) is strongly associated with HIV transmission, and we have identified prevalence HSV-2 as a major factor associated with HIV transmission among NIDUs in NYC. The specific aims of the proposed research include: 1) Monitoring risk behavior, HIV prevalence and incidence and service utilization in the continuing evolution of the HIV epidemic among NIDUs and IDUs in New York City. 2) Quantifying the long-term population-level relationships between HIV and HSV-2 infections among heroin and cocaine users in NYC, including testing the hypothesis that the strength of the association between HSV-2 and HIV increases over time. Recent intervention studies have dramatically increased the need for understanding HSV-2/HIV relationships. 3) Evaluating effects of the New York City Department of Health (NYC DOH) Condom Social Marketing campaign on sexual risk behaviors and HIV and HSV-2 infection among IDUs and NIDUs in NYC. 4) Monitoring patterns of sexual and injection related HIV transmission among IDUs in NYC. There are many linkages between NIDUs and IDUs in NYC. NIDUs and IDUs are best viewed as linked groups within a single population of heroin and cocaine users in NYC. A thorough understanding of sexual transmission among NIDUs requires an understanding of both injecting and sexual transmission among IDUs in the city. 5) Assess new patterns of racial/ethnic differences in HIV infection among NIDUs and IDUs. 6) Intervention development. These aims will be accomplished through continuation of our studies of NIDUs and IDUs entering Beth Israel drug treatment programs in NYC. The proposed research will be the first study of the spread of HIV over time in a very large population of NIDUs, the first assessment of change in the relationship of HVS-2 to HIV over time among NIDUs, and the first assessment of the effects of a very large condom social marketing campaign on sexual risk behavior of NIDUs and IDUs. PUBLIC HEALTH RELEVANCE: Sexual transmission of HIV among non-injecting drug users has become a major public health problem in the US. This study will generate an in-depth understanding of the largest HIV epidemic among NIDUs in the US.