Epidemiology of HIV and Hepatitis C Among Injecting Drug Users in Tijuana

描述(由申请人提供)：该项目的总体目标是描述墨西哥提华纳注射吸毒者中艾滋病毒和丙型肝炎病毒的流行病学特征。最近的数据表明，在墨西哥西北部-美国边境的注射吸毒者中，艾滋病毒亚流行呈动态趋势，在那里，注射毒品现在是一个主要的公共卫生问题。这项建议的目的是：1)确定艾滋病毒、丙型肝炎病毒和梅毒的流行率，并根据提华纳注射吸毒者中的非调谐检测来估计艾滋病毒发病率；2)确定感染的程度。这些潜在可改变的个人、社会和环境因素影响提华纳注射吸毒者的下列结果：i)艾滋病毒和丙型肝炎的流行以及艾滋病毒感染事件；ii)血液传播感染的危险行为(例如，直接和间接共用注射器、观看射击场)；iii)在通过药房合法获得注射器的情况下获取和使用无菌注射器和注射用具的障碍。感兴趣的个人因素包括对艾滋病毒和丙型肝炎病毒血清状态的了解、最近发病的注射和使用特定注射药物组合(例如海洛因和甲基苯丙胺)和制剂(例如海洛因焦油和粉末)；社会因素包括移民和个人网络特征；环境因素包括地理空间因素(例如距离边境的距离、过境频率、射击馆密度、药店和戒毒方案)以及执法经验。3)审查蒂华纳下列利益攸关方减少毒品相关伤害的干预措施的社会可接受性。为了达到目标1和目标2，在前6个月内至少注射过一次的2000名注射吸毒者将被招募，采用受访者驱动抽样，这将有助于对艾滋病毒和丙型肝炎病毒流行率和相关危险行为进行公正的估计。面对面的访谈将收集社会人口和行为数据。为了评估地理空间因素，我们将使用手持全球定位系统设备来绘制射击画廊、药店和药物治疗项目的十字街位置。为了实现目标3，我们将深入约谈三类主要举报人(例如，系统、互动者和街头一级的主要举报人)。虽然墨西哥被认为是艾滋病毒/艾滋病低流行率和集中流行的国家，但人们认为预防的机会之窗正在迅速关闭，因为与注射吸毒者相关的艾滋病毒流行往往具有爆炸性，并可能很快蔓延开来。这项研究将为在墨西哥-美国最大的城市之一发展适合文化的干预措施提供信息，这对两国的政策制定和项目规划都有影响。

DESCRIPTION (provided by applicant): The overall goal of this project is to characterize the epidemiology of HIV and HCV among injecting drug users (IDUs) in Tijuana, Mexico. Recent data suggest a dynamic HIV sub-epidemic among IDUs on the northwestern Mexico-US border where injection drug use is now a major public health problem. The aims of this proposal are: 1) To determine HIV, HCV and syphilis prevalence and estimate HIV incidence based on the detuned assay among IDUs in Tijuana; 2) To determine the extent to. which potentially modifiable individual, social and environmental factors influence the following outcomes among IDUs in Tijuana: i) prevalent HIV and HCV and incident HIV infections; ii) risk behaviors for blood borne infections (e.g., direct and indirect syringe sharing, shooting gallery attendance); iii) barriers to access and use of sterile syringes and injection paraphernalia within the context of legal syringe access through pharmacies. Individual level factors of interest include knowledge of HIV and HCV serostatus, recent onset injection and use of specific injection drug combinations (e.g., heroin and methamphetamine) and formulations (e.g., heroin tar versus powder); Social factors include emigration and personal network characteristics; Environmental factors include geospatial factors (e.g., distance from the border, frequency of border crossings, density of shooting galleries, pharmacies and drug treatment programs), and experiences with law enforcement. 3) To examine the social acceptability of interventions to reduce drug-related harm among the following stakeholders in Tijuana. To meet Aims 1 and 2, 2000 IDUs who have injected at least once in the prior 6 months will be recruited using respondent driven sampling, which will facilitate an unbiased estimate of HIV and HCV prevalence and associated risk behaviors. Face-to-face interviews will collect sociodemographic and behavioral data. To assess geospatial factors, we will use hand-held global positioning system devices to map cross-street locations of shooting galleries, pharmacies and drug treatment programs. To meet Aim 3,we will conduct in-depth interviews with three types of key informants (e.g., systems, interactor and street-level key informants). Although Mexico is considered a country of low HIV/AIDS prevalence with a concentrated epidemic, the window of opportunity for prevention is believed to be closing rapidly since IDU-associated HIV epidemics are often explosive and can quickly become generalized. This study will inform the development of culturally-appropriate interventions in one of the largest Mexican-U.S. cities, which has implications for policy making and program planning for both countries.