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.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Lambert, Elizabeth
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National Development & Research Institutes
New York
United States
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Friedman, Samuel R; Pouget, Enrique R; Sandoval, Milagros et al. (2017) Interpersonal Attacks on the Dignity of Members of HIV Key Populations: A Descriptive and Exploratory Study. AIDS Behav 21:2561-2578
Pouget, Enrique R; Sandoval, Milagros; Nikolopoulos, Georgios K et al. (2016) Developing Measures of Pathways that May Link Macro Social/Structural Changes with HIV Epidemiology. AIDS Behav 20:1808-20
Friedman, Samuel R; Tempalski, Barbara; Brady, Joanne E et al. (2016) Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research. Int J Drug Policy 32:11-6
Friedman, Samuel R; Pouget, Enrique R; Sandoval, Milagros et al. (2015) Measuring Altruistic and Solidaristic Orientations Toward Others Among People Who Inject Drugs. J Addict Dis 34:248-54
Nikolopoulos, Georgios K; Fotiou, Anastasios (2015) ""Integrated interventions are dead. Long live sustainable integrated interventions!""--Austerity Challenges the Continuation of Effective Interventions in the Field of Drug Use-Related Harm Reduction. Subst Use Misuse 50:1220-2
Nikolopoulos, Georgios K; Sypsa, Vana; Bonovas, Stefanos et al. (2015) Big Events in Greece and HIV Infection Among People Who Inject Drugs. Subst Use Misuse 50:825-38
Friedman, Samuel R; Pouget, Enrique R; Sandoval, Milagros et al. (2015) Formal and informal organizational activities of people who inject drugs in New York City: description and correlates. J Addict Dis 34:55-62
Pouget, Enrique R; Sandoval, Milagros; Nikolopoulos, Georgios K et al. (2015) Immediate Impact of Hurricane Sandy on People Who Inject Drugs in New York City. Subst Use Misuse 50:878-84
Friedman, Samuel R; Rossi, Diana (2015) Some Musings About Big Events and the Past and Future of Drug Use and of HIV and Other Epidemics. Subst Use Misuse 50:899-902
Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria et al. (2014) The staying safe intervention: training people who inject drugs in strategies to avoid injection-related HCV and HIV infection. AIDS Educ Prev 26:144-57

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