Community Vulnerability and Responses to Drug-User-Related HIV/AIDS

社区对吸毒者相关艾滋病毒/艾滋病的脆弱性和应对措施

• 批准号: 7895659
• 负责人: SAMUEL R FRIEDMAN
• 金额: $ 64.59万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-08-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7895659
• 关键词: AIDS diagnosis; AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Age; Amphetamines; Area; Budgets; Caring; Categories; Centers for Disease Control and Prevention (U.S.); Cities; Cocaine; Cohort Studies; Communities; Computer Simulation; Counseling; Country; Crack Cocaine; Cross-Sectional Studies; Data; Data Analyses; Development; Diagnosis; Distant; Drug abuse; Drug usage; Drug user; Economic Conditions; Economics; Environment; Epidemic; Epidemiology; Etiology; Evidence based program; Foreclosure; Fright; Funding; Future; Gender; HIV; HIV Seropositivity; HIV Seroprevalence; HIV diagnosis; Health; Health Insurance; Heroin; Heroin Users; Highly Active Antiretroviral Therapy; Imprisonment; Incidence; Individual; Injecting drug user; Injection of therapeutic agent; Insurance Coverage; International AIDS; Intervention; Knowledge; Laws; Lead; Learning; Life; Local Government; Longitudinal Studies; Measures; Medical; Methamphetamine; Methods; Mexico; Modeling; Monitor; Morbidity - disease rate; Needle-Exchange Programs; New York; Outcome; Pattern; Pharmaceutical Preparations; Phase; Police; Policies; Political Activities; Politics; Population; Population Characteristics; Population Density; Populations at Risk; Prevalence; Prevention; Prevention program; Process; Progress Reports; Public Health; Punishment; Recruitment Activity; Research; Research Design; Research Personnel; Resolution; Resources; Risk; Risk Behaviors; Services; Sex Characteristics; Shapes; Social Change; Social Conditions; Social Environment; Social Policies; Syringes; System; Testing; Time; Unemployment; United States Substance Abuse and Mental Health Services Administration; Variant; Youth; aged; base; comparative; contextual factors; cost effectiveness; evidence base; experience; falls; high risk; insight; metropolitan; models and simulation; mortality; programs; public health relevance; racial and ethnic; racial and ethnic disparities; racism; response; segregation; social; social integration; social movement; symposium; theories; transmission process; trend

DESCRIPTION (provided by applicant): This is a competing continuation application for the Community Vulnerability and Responses to Drug-User- Related HIV/AIDS study of why large US metropolitan areas vary over time in their vulnerability to HIV/AIDS among drug users and in their responses-i.e., in policies and programs that may affect the epidemic. Drug use and HIV epidemics change over time. In the last funding period, we showed that HIV prevalence in the 96 largest US metropolitan areas declined among injection drug users (IDUs) from 1992 to 2002, and that the population prevalence of IDUs declined in these areas from 1992 to 2000, but then began to rise again. We also showed that metropolitan areas varied in these trajectories, and that a variety of social and policy forces shaped IDU prevalence, racial disparities in IDU prevalence, HIV prevalence among IDUs, racial disparities in AIDS prevalence among IDUs, drug abuse treatment coverage, and syringe exchange access and coverage. Ominously, our recent analyses indicate that the prevalence of IDUs among youth (aged 15 - 29) has begun to rise. Further, as others have shown, HIV has spread widely among NIDUs (non-injecting users of heroin, cocaine, crack, amphetamines or methamphetamine) in some metropolitan areas. These changes are occurring against the backdrop of an economy that has recently shifted from slow to rapid decline, a shift that will lead to great difficulty in maintaining, let alone expanding, services for drug users. Therefore, the Specific Aims of this proposed continuation are: 1. To describe trends, in the 96 largest US metropolitan areas from 1992 - 2012, in (a) critical epidemiologic outcomes (population prevalence of IDUs and NIDUs, and particularly their prevalence among youth; and, among IDUs, HIV prevalence, late-diagnosis HIV cases, and AIDS incidence and mortality) as well as in (b) the implementation of evidence-based drug- related interventions (drug abuse treatment, syringe exchange, HIV counseling and testing) and (c) non- evidence-based drug-related interventions (incarceration and arrests of drug users). 2. To understand how macro-social contexts (e.g., economic changes, social integration, racial residential segregation) and epidemiologic need affect interventions; how interventions and macro-social contexts together affect epidemiologic contexts; how some interventions (e.g., arrests, incarceration) affect others (e.g., syringe exchange coverage); and how some epidemiologic outcomes (e.g., prevalence of young IDUs) affect others (e.g., HIV prevalence). 3. To develop an integrated theory, using agent based modeling, of how these processes interact and thus what the impacts of various intervention mixes are likely to be in given social contexts. 4. To disseminate estimates, results and theoretical understandings to public health agencies and continue to advise them on how they might respond. PUBLIC HEALTH RELEVANCE: This project will estimate changes in injection and non-injection drug use, in HIV, AIDS and AIDS mortality rates among injection drug users, and in drug- and HIV-related interventions among drug users, in 96 large metropolitan areas over a 21-year period (1992 - 2012). We will investigate how these epidemics and interventions affect one another, and how macro-contextual factors like economic and social conditions shape them both. We will identify metropolitan areas in which serious drug use, HIV or AIDS epidemics are emerging, and offer state and local health departments and drug agencies the best information available on policies and programs that might reduce these epidemics. Our findings will also help national public health agencies, including the CDC and SAMHSA, and other researchers, plan a mixture of evidence-based programs and policies to reduce the forces that lead to high-risk drug use and the associated HIV and AIDS epidemics.

描述（由申请人提供）：这是针对社区脆弱性的竞争性延续申请，以及对药物使用者与艾滋病毒相关的艾滋病毒/艾滋病的反应研究，为什么大型美国大都市地区在吸毒者中及其艾滋病毒/艾滋病的脆弱性以及对艾滋病的脆弱性以及在其反应中的脆弱性而有所不同。药物使用和艾滋病毒流行病随着时间的流逝而变化。在最后一个融资期间，我们表明，从1992年到2002年，注射吸毒者（IDUS）中96个最大的美国大都市地区的艾滋病毒患病率下降了，而IDUS的人口流行率从1992年到2000年在这些地区下降，但随后又开始上升。我们还表明，这些轨迹在大都市地区各不相同，并且各种社会和政策力量塑造了IDU的流行，IDU患病率的种族差异，IDU之间的艾滋病毒患病率，IDUS的种族差异，IDUS中的艾滋病患病率，毒品滥用治疗覆盖范围以及注射剂的交流和注射范围和承保范围。不祥的是，我们最近的分析表明，IDU的患病率（15-29岁）已经开始上升。此外，正如其他人所表明的那样，艾滋病毒已在某些大都市地区广泛传播（非注射海洛因，可卡因，裂缝，苯丙胺或甲基苯丙胺）。这些变化正在从最近从缓慢下降变为迅速下降的经济背景，这一转变将导致对吸毒者服务的维持，更不用说扩大的服务。因此，该提出的延续的具体目的是：1。描述趋势，在1992年至2012年的96个美国大都市地区中，在（a）（a）关键的流行病学结果（iDus和nidus的人口普遍存在，尤其是年轻人中的普遍性，尤其是在IDUS中，艾滋病毒的患者以及艾滋病毒的疾病，以及艾滋病毒的病例，以及艾滋病病人，以及艾滋病的病例，以及艾滋病的病例，以及艾滋病的病情，以及艾滋病的病情，以及艾滋病）。基于证据的药物相关干预措施（药物滥用治疗，注射器交换，艾滋病毒咨询和测试）以及（c）非证据与药物有关的干预措施（监禁和逮捕吸毒者）。 2。了解宏观社会环境（例如，经济变化，社会融合，种族隔离）和流行病学需求如何影响干预措施；干预措施和宏观社会环境如何共同影响流行病学环境；某些干预措施（例如逮捕，监禁）如何影响其他干预措施（例如注射器交换覆盖范围）；以及某些流行病学结果（例如，年轻IDU的患病率）如何影响其他结果（例如，HIV患病率）。 3。为了开发一种基于代理的建模，这些过程如何相互作用，因此在给定的社会环境中可能是什么影响。 4.为了传播对公共卫生机构的估计，结果和理论理解，并继续向他们提供有关他们如何反应的建议。 公共卫生相关性：该项目将在注射吸毒者的艾滋病毒，艾滋病和艾滋病中估计注射和非注射药物使用的变化，以及在21年的96个大都市地区（1992 - 2012年）在96个大都市地区，在96个大都市中，在96个大都市中，在药物和艾滋病毒相关的干预措施中的死亡率将发生变化。我们将研究这些流行病和干预措施如何相互影响，以及诸如经济和社会状况之类的宏观上的因素如何影响它们。我们将确定正在出现严重吸毒，艾滋病毒或艾滋病流行病的大都市地区，并为州和地方卫生部门和毒品机构提供有关可能减少这些流行病的政策和计划的最佳信息。我们的发现还将帮助包括CDC和SAMHSA在内的国家公共卫生机构，以及其他研究人员，计划将基于证据的计划和政策组合在一起，以减少导致高风险吸毒的力量以及相关的HIV和AIDS流行病学。