Drug Use, Housing Access, Stability and HIV Risk among Low-Income Urban Residents

描述（由申请人提供）：这项为期4年的研究题为“低收入城市居民的吸毒、住房获得、稳定性和艾滋病毒风险”，旨在探讨住房结构因素（获得住房补贴和方案、地位和稳定性）与吸毒者艾滋病毒风险之间的关系。拟议的项目将检验以下假设：吸毒者获得联邦、州和地方住房补贴和方案的机会少于低收入非吸毒者，住房不稳定增加了吸毒者感染艾滋病毒的风险。拟议研究的具体目的包括以下内容：1）在控制个人特征的情况下，比较两个研究城镇中低收入吸毒者和低收入非吸毒者获得住房和社会服务的情况，以及他们随着时间的推移的住房稳定性; 2）检查住房获取在毒品使用和住房状况/稳定性之间的中介关系;（3）探讨吸毒和非吸毒低收入居民的住房状况与艾滋病风险的关系;以及4）探讨不同支持性住房计划提供的计划要求和支持服务的差异及其对申请人获得支持性住房计划的影响，维持住房稳定，以及吸毒和艾滋病毒危险行为。为了探索这4个目标，我们将在基线、6个月和12个月对哈特福德和东哈特福德的300名吸毒和150名非吸毒低收入居民进行纵向调查。两个社区的低收入居民将通过有针对性的抽样招募，使用探索性定性研究（R21 DA 018607）中开发的工具。我们将通过直接在提供支持性住房的机构招募100名支持性住房计划的居民作为这一较大样本的一部分，以确保足够的样本量。该调查包括住房状况和稳定性、获得住房补贴、支助性住房、福利和健康福利、邻里特征、健康和心理健康状况、吸毒和艾滋病毒风险行为的详细措施。此外，我们还将通过绘制二手房数据和使用地理空间分析对住房可用性进行建模，来探索社区层面的住房获取情况（租赁住房单元数量、空置率、支持性和低收入住房数量、避难所数量）。还将通过绘制和地理空间建模毒品相关和暴力逮捕以及与参与者住所相关的废弃建筑物的位置，或者如果无家可归，他们最常过夜的位置，在社区一级评估风险。为了更充分地探索不同的支持性住房计划的理念和计划要求的差异，作为目标4的一部分，我们将对研究城镇的5个支持性住房计划中的每一个的服务提供者进行深入访谈。这一探索性的目标将使我们能够制定措施和关系，以更充分地评估不同的支持性住房计划在随后的研究。该项目提供的信息将有助于查明限制吸毒者获得住房和造成其住房不稳定的结构性条件。这类信息将大大有助于制定干预措施，减少吸毒者易受艾滋病毒感染的一些根本原因，包括为无家可归风险高的活跃吸毒者开发新的住房替代办法，解决无家可归吸毒者的背景风险因素的艾滋病毒预防干预措施，以及改善吸毒者获得住房和总体健康的政策建议。

DESCRIPTION (provided by applicant): The purpose of this 4 year study entitled "Drug Use, Housing Access, Stability and HIV Risk among Low- Income Urban Residents" is to explore the relationship between structural factors of housing (access to housing subsidies and programs, status and stability) and HIV risk among drug users. The proposed project will test hypotheses that drug users have less access to federal, state and local housing subsidies and programs than low-income non-drug users, and that housing instability increases drug users' HIV risk. The specific aims of the proposed study include the following: 1) To compare low-income drug users' and low- income non-drug users' access to housing and social services, and their housing stability over time in the two study towns controlling for personal characteristics; 2) To examine the mediating relationship of housing access between drug use and housing status/stability; 3) To examine the relationship between housing status and HIV risk for drug using and non-drug using low-income residents; and 4) To explore differences in program requirements and supportive services offered by different supportive housing programs and their impact on applicants' access to supportive housing programs, maintenance of housing stability, and drug use and HIV risk behaviors. To explore these 4 aims, we will conduct longitudinal surveys with a cohort of 300 drug using and 150 non-drug using low-income residents of Hartford and East Hartford at baseline, 6 and 12 months. Low-income residents of the two communities will be recruited through targeted sampling, using an instrument developed in an exploratory qualitative study (R21 DA 018607). We will over-recruit 100 residents of supportive housing programs as part of this larger sample by directly recruiting at the agencies that provide supportive housing in order to ensure sufficient sample size. The survey includes detailed measures of housing status and stability, access to housing subsidies, supportive housing, welfare and health benefits, neighborhood characteristics, health and mental health status, drug use and HIV risk behaviors. In addition, we will explore housing access at the neighborhood level (number of rental housing units, vacancy rates, number of supportive and low-income housing, number of shelters) by mapping secondary housing data and modeling housing availability using geospatial analysis. Risk will also be assessed at the neighborhood level by mapping and geospatial modeling of drug related and violent arrests, and locations of abandoned buildings in relation to participants' residences or, if homeless, the location/s where they most frequently spend the night. In order to explore more fully the differences in philosophy and program requirements of different supportive housing programs as part of aim 4, we will conduct in-depth interviews with service providers in each of the 5 supportive housing programs in the study towns. This exploratory aim will allow us to develop measures and relationships to more fully evaluate different supportive housing programs in a subsequent study. Information from this project will allow identification of structural conditions that limit drug users' access to housing and contribute to their housing instability. Such information will contribute significantly to the development of interventions to reduce some of the root causes of drug users' vulnerability to HIV infection, including developing new housing alternatives for active drug users at high risk for homelessness, HIV prevention interventions that address contextual risk factors of homeless drug users, and policy recommendations to improve drug users' access to housing and overall health.