Social networks and HIV risk among rural drug users

描述（由申请人提供）：本申请是对PA-06-478“农村精神健康和药物滥用障碍研究”的回应。本PA强调的研究领域之一是使用社会网络分析来检查农村艾滋病毒的传播。这项研究的总体目标是使用社会网络分析和多层次建模，在阿巴拉契亚农村吸毒者中研究艾滋病毒和其他血液传播感染（BBIs）（如B肝炎（HBV）和丙型肝炎（HCV））的患病率，发病率和风险因素。艾滋病毒仍然是美国的一个主要公共卫生问题，特别是在吸毒者中。然而，对农村地区的艾滋病毒知之甚少，农村地区存在明显的健康差距。因此，鉴于对城市吸毒者的研究发现，社会网络指标是艾滋病毒风险的可靠预测指标，将衡量社会网络和个人特征与农村吸毒者艾滋病毒风险的关系。具体目标是：1）确定农村注射和非注射吸毒者中HIV、HCV和HBV的患病率和发病率; 2）检查农村注射和非注射吸毒者中HIV和其他BBI风险; 3）检查基线后6个月、12个月和18个月农村HIV、HCV和HBV风险的纵向变化。为了实现这些目标，样本500农村注射和非注射吸毒者将招募采用受访者驱动抽样（RDS）。除了HIV、HCV和HBV的生物学检测外，还将向农村参与者提供一份由访谈者管理的问卷，内容涉及他们的社交网络（毒品、性和支持网络）、社会人口统计学、毒品使用、HIV风险行为、精神病诊断、干预和规范。由于个人将嵌套在网络中，因此将使用多层次随机效应回归分析数据，从而可以同时检查社交网络和个人水平的风险。与NIDA艾滋病研究计划的优先事项相一致，该提案将探讨农村吸毒人群的社会网络结构，以更好地了解网络因素如何影响农村地区的艾滋病毒风险，采用创新的多层次方法。拟议研究的结果将为农村地区艾滋病毒干预措施的设计和实施提供信息，并有助于确定此类活动的目标人群，以降低与艾滋病毒和其他BBI相关的发病率和死亡率。 尽管艾滋病毒在美国仍然是一个重大的公共卫生问题，特别是在吸毒者中，但人们对阿巴拉契亚等农村地区的艾滋病毒风险知之甚少。在城市人口中已经表明，吸毒者之间的关系，也称为社交网络，是艾滋病毒风险的重要预测因素。因此，本研究旨在通过测量社会网络和个人行为来描述农村艾滋病毒风险，以便为卫生资源匮乏的农村地区的预防活动提供信息。

DESCRIPTION (provided by applicant): This application is in response to PA-06-478, "Research on Rural Mental Health and Drug Abuse Disorders". One of the research areas highlighted by this PA is the examination of rural HIV transmission using social network analysis. The overall goal of the study is to examine the prevalence, incidence, and risk factors for HIV and other blood borne infections (BBIs) such as hepatitis B (HBV) and C (HCV) among rural Appalachian drug users using social network analysis and multilevel modeling. HIV continues to be a major public health problem in the United States, especially among drug users. However, little is known about HIV in rural areas in which there are marked health disparities. Therefore, given that studies among urban drug users have found that social network indicators are robust predictors of HIV risk, both social network and individual characteristics will be measured for their association with HIV risk among rural drug users. The specific aims are: 1) To determine the prevalence and incidence of HIV, HCV and HBV among rural injection and non- injection drug users; 2) To examine HIV and other BBI risk among rural injection and non-injection drug users; and 3) To examine longitudinal changes in rural HIV, HCV and HBV risk at 6-months, 12-months and 18- months post-baseline. To meet these aims, a sample 500 rural injection and non-injection drug users will be recruited using respondent driven sampling (RDS). In addition to biologic testing for HIV, HCV and HBV, rural participants will be given an interviewer-administered questionnaire pertaining to their social networks (drug, sexual and support networks), sociodemographics, drug use, HIV risk behaviors, psychiatric diagnoses, intravention and norms. Since individuals will be nested within networks, data will be analyzed using multilevel random effects regression that allows for the simultaneous examination of social network and individual-level risk. Consistent with the priorities of the NIDA AIDS Research Program, this proposal will explore the social network structure in a rural drug using population in order to better understand how network factors may affect HIV risk in rural areas using an innovative multilevel approach. Results from the proposed study will inform the design and implementation of HIV interventions in rural areas and help to determine the appropriate population for which to target such activities in order to reduce the morbidity and mortality associated with HIV and other BBIs. Although HIV remains a significant public health problem in the United States, especially among drug users, little is known about HIV risk in rural areas such as Appalachia. It has been shown in urban populations that relationships among drug users, also known as social networks, are important predictors of HIV risk. Therefore, this study seeks to characterize rural HIV risk by measuring both social network and individual behaviors in order to inform prevention activities in health resource-deprived rural areas.