Recent studies suggest that HIV epidemics are diffusing out from injecting drug using communities into the general population through heterosexual transmission, the extent & speed of diffusion remains unknown. The objectives of this study are: (1) to assess the likely extent of such diffusion & (2) to provide an objective & logical framework for making rational comparisons of different ways of deploying behavioral & medical intervention strategies. To achieve these objectives I have five specific aims: . to understand the dynamics of heterosexual & injecting drug use transmission within injecting drug using communities. . to quantify the epidemiological impact of the sexual mixing between injecting drug users (IDU) & their non-injecting sex partners. . to understand the effect that past & current changes in injecting & heterosexual behavior have had (& will have) on seroprevalence levels & AIDS incidence rates. . to assess the epidemiological consequences of a variety of possible behavioral intervention strategies that change injecting &/or sexual behaviors in IDU & their non-injecting sex partners. . to assess the epidemiological consequences of a variety of possible medical intervention strategies in IDU & their non-injecting sex partners. I will assess the effects of vaccines that prevent infection & the effects of therapeutic treatments that slow disease progression. I plan to adopt two complementary approaches to achieve my specific aims: to develop & to apply data analytic techniques to specific data sets, & to formulate & analyze HIV transmission models. I am collaborating with Dr. Schoenbaum in New York City, Dr. Moss in San Francisco & Dr. Coutinho in Amsterdam, The Netherlands. All three of these investigators are in charge of cohorts of injecting drug users, all three cohorts have been followed for a number of years & were designed as longitudinal studies of HIV transmission. I will collaborate closely with these investigators & use their data sets to estimate parameter values for the transmission models & to identify mechanisms of risk behavior change. The HIV epidemics due to injecting drug use & heterosexual transmission have been significantly different in NYC, San Francisco & Amsterdam. I am proposing to use data from the three cities to explain this geographic variation. I am also collaborating with Dr. Nickolas Jewell in my development of data analytic techniques.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
5R29DA008153-05
Application #
2377384
Study Section
Sociobehavioral Subcommittee (DAAR)
Project Start
1993-03-01
Project End
1998-02-28
Budget Start
1997-03-01
Budget End
1998-02-28
Support Year
5
Fiscal Year
1997
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
073133571
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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