Developing measures to study how structural interventions may affect HIV risk

描述(申请人提供)：尽管采取了所有预防措施，但美国每年仍有56,000例新的艾滋病毒感染病例。该领域的领导者呼吁进行“结构性”或“社会性”干预，以影响风险环境、网络和社会规范，从而影响危险行为和/或未感染艾滋病毒的人与感染者发生性行为或注射毒品的可能性。制定有效的结构性干预措施将是困难的，需要进行大量研究。就像艾滋病毒行为干预、疫苗试验和杀微生物剂研究一样，最初的结构性干预努力可能只会取得部分成功(如果是这样的话)。为了从这些试验中学习，至关重要的是能够衡量将干预目标--通常是法律、组织特征或社会计划(如住房供应)--与行为、风险环境或风险网络的变化，进而与性传播感染或艾滋病毒发病率联系起来的途径。该项目旨在制定可靠和有效的措施，以确定上游变化或干预措施与感染直接原因之间的重要中间途径。这些途径将包括：a.个人感知的直接社会环境；b.个人的生活是如何构成的，可能会影响他们对环境变化的反应；以及c.个人如何应对来自环境中其他人的规范影响(以及他们由此形成的规范)。该项目的具体目标是开发这些措施；评估它们的可靠性和同时标准的有效性；然后描述这些变量在具有合理代表性的注射吸毒者、高危异性恋者和纽约市(美国艾滋病毒流行的中心)男男性行为者样本中的分布。我们将通过使用人种学方法来制定措施来做到这一点；然后通过调查290名注射吸毒者、290名高危异性恋者和290名男男性行为者来描述他们的心理测量特征和他们的人口分布。我们将向美国和全球的研究人员提供这些措施，以便他们能够使用这些措施--也许是以其他国家具有文化能力的改良形式--来开发和评估结构性干预措施；并在一个联合研究领域--了解大规模社会变化，如战争或大规模社会经济变化，有时会导致或有时不会导致艾滋病毒流行。 与公共卫生相关：尽管做出了所有研究和预防努力，但美国每年仍有56000例新的艾滋病毒感染病例。许多研究人员和公共卫生当局呼吁开展研究，开发“结构性干预”，改变社会和规范背景，使人们能够更容易地避免艾滋病毒风险。我们的目标是开发新的衡量工具，让我们了解这种结构性干预措施起或不起作用的原因和方式--这是制定有效干预措施所需研究的重要部分。

DESCRIPTION (provided by applicant): In spite of all prevention efforts, 56,000 new HIV infections take place in the USA each year. Leaders in the field are calling for "structural" or "social" interventions that affect the risk environments, networks and social norms that influence risk behaviors and/or the probability that an HIV uninfected person will engage in sex or drug injection with an infected person. Developing structural interventions that work will be difficult and will require considerable research. As has been the case with HIV behavioral interventions, vaccine trials and microbicide research, initial structural intervention efforts are likely to meet only partial success (if that). In order to learn from these trials, it is essential to be able to measure the pathways that connect the target of the intervention-typically, a law, an organizational characteristic, or a social program such as housing provision- to changes in behaviors, risk environments or risk networks and then to STI or HIV incidence. This project aims to develop reliable and valid measures of important intermediate pathways between upstream changes or interventions and the immediate causes of infection. These pathways will include a. individuals' perceived immediate social environments; b. how individuals' lives are structured in ways that might affect how they react to changes in their environments; and c. how individuals react to normative influence from others in their environments (and the norms they develop as a result). The specific aims of the project are to develop these measures; to assess their reliability and concurrent criterion validity; and then to describe the distributions of these variables among reasonably representative samples of injection drug users, high-risk heterosexuals, and men who have sex with men in New York City (the epicenter of the US HIV epidemic). We will do this by using ethnographic approaches to develop the measures; and then by surveying 290 injection drug users, 290 high-risk heterosexuals, and 290 men who have sex with men to describe their psychometric properties and their population distributions. We will make these measures available to researchers in the USA and globally so they can use them - perhaps in modified culturally competent form for other countries - to develop and evaluate structural interventions; and, in an allied research area - to understand how large-scale social changes like wars or large-scale socioeconomic changes sometimes do and sometimes do not lead to HIV epidemics. PUBLIC HEALTH RELEVANCE: Despite all research and prevention efforts, 56,000 new HIV infections take place in the United States each year. Many researchers and public health authorities are calling for research to develop "structural interventions" that change social and normative contexts so people can more easily avoid HIV risk. We aim to develop new measurement tools to let us understand why and how such structural interventions do or do not work-which is an essential part of the research needed to develop effective interventions.