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）：这是一项针对吸毒者相关艾滋病毒/艾滋病社区脆弱性和应对研究的竞争性延续申请，该研究旨在解释为什么美国大都市地区吸毒者和吸毒者感染艾滋病毒/艾滋病的脆弱性随时间而变化。他们的反应，即可能影响该流行病的政策和计划。吸毒和艾滋病毒流行随着时间的推移而变化。在上一个资助期间，我们发现，从 1992 年到 2002 年，美国 96 个最大的都市地区注射吸毒者 (IDU) 的艾滋病毒流行率有所下降，并且这些地区的 IDU 人群流行率从 1992 年到 2000 年也有所下降，但随后开始再次崛起。我们还表明，大都市地区的这些轨迹各不相同，并且各种社会和政策力量影响了注射吸毒者患病率、注射吸毒者患病率的种族差异、注射吸毒者中艾滋病毒患病率、注射吸毒者中艾滋病患病率的种族差异、药物滥用治疗覆盖率和注射器交换访问和覆盖范围。不幸的是，我们最近的分析表明，青少年（15 至 29 岁）中注射吸毒者的流行率已开始上升。此外，正如其他人所表明的那样，艾滋病毒已在一些大都市地区的 NIDU（非注射海洛因、可卡因、快克、安非他明或甲基苯丙胺使用者）中广泛传播。这些变化是在经济最近从缓慢衰退转向快速衰退的背景下发生的，这种转变将导致维持为吸毒者提供的服务面临巨大困难，更不用说扩大服务了。因此，本次拟议延续的具体目标是： 1. 描述 1992 年至 2012 年美国 96 个最大都市区 (a) 关键流行病学结果（IDU 和 NIDU 的人口流行率，特别是青少年中的流行率）的趋势；以及注射吸毒者中艾滋病毒感染率、晚期诊断艾滋病毒病例以及艾滋病发病率和死亡率）以及 (b) 实施基于证据的药物治疗相关干预措施（药物滥用治疗、注射器交换、艾滋病毒咨询和检测）和 (c) 非循证药物相关干预措施（监禁和逮捕吸毒者）。 2. 了解宏观社会背景（例如经济变化、社会融合、种族居住隔离）和流行病学需求如何影响干预措施；干预措施和宏观社会背景如何共同影响流行病学背景；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）；以及一些流行病学结果（例如，年轻注射吸毒者的流行率）如何影响其他流行病学结果（例如，艾滋病毒流行率）。 3. 使用基于主体的建模来开发一个综合理论，说明这些过程如何相互作用，以及各种干预组合在特定社会背景下可能产生的影响。 4. 向公共卫生机构传播估计、结果和理论理解，并继续就如何应对提供建议。 公共卫生相关性：该项目将估计 96 个大城市地区注射吸毒和非注射吸毒的变化、注射吸毒者中艾滋病毒、艾滋病和艾滋病死亡率的变化，以及吸毒者中吸毒和艾滋病毒相关干预措施的变化。 21 年期间（1992 年 - 2012 年）。我们将研究这些流行病和干预措施如何相互影响，以及经济和社会条件等宏观背景因素如何影响它们。我们将确定正在出现严重吸毒、艾滋病毒或艾滋病流行的大都市地区，并向州和地方卫生部门和药物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。我们的研究结果还将帮助国家公共卫生机构，包括 CDC 和 SAMHSA 以及其他研究人员，规划一系列基于证据的计划和政策，以减少导致高风险吸毒和相关艾滋病毒和艾滋病流行的力量。