Brief:In the 2012 US Presidential election, America’s healthcare policies remain hotly disputed. But the issue of drugs and addiction, formerly a prominent public and health concern, is now largely invisible in national political debates. Its public health importance is overlooked in favour of the continued criminalisation and punishment of drug users. America’s HIV/AIDS epidemic, for example, has always implicated drug use among poor and minority communities. New HIV infections in the USA continue at a high rate: the US Centers for Disease Control and Prevention estimate 50 000–60 000 new HIV infections in the USA annually. Meanwhile in the more populous European Union, researchers estimate there were about 5000 new HIV infections in 2008—less than 10% of the US incidence. In the USA, drug offences feed the nation’s bloated prison system, and damage the social and economic prospects of America’s poorest families and communities. There are now more drug offenders in US prisons and gaols (more than 1 million) than prisoners in the European Union for all offences. These are vital social and public health matters for the USA, as measured by morbidity and mortality alone, yet are ignored in our Presidential politics. From Afghanistan, to US neighbour Mexico, where violence associated with the trade in illicit drugs has produced 60 000 murders in 6 years, and Central America, a region which now has the highest murder rate in the world, the candidates look away, as the deadly medical and social toll accumulates.
Theory, Measurement and Hard Times: Some issues for HIV/AIDS research
Friedman, Samuel R
Pouget, Enrique R
Economic and political instability and related “big events” are widespread throughout the globe. Although they sometimes lead to epidemic HIV outbreaks, sometimes they do not—and we do not understand why. Current behavioural theories do not adequately address these processes, and thus cannot provide optimal guidance for effective intervention. Based in part on a critique of our prior “pathways” model of big events, we suggest that Cultural-Historical Activity Theory (CHAT) may provide a useful framework for HIV research in this area. Using CHAT concepts, we also suggest a number of areas in which new measures should be developed to make such research possible.
Key Words: Big events, hard times, cultural historical activity theory, theory, HIV, measurement
Topological and Historical Considerations for Infectious Disease Transmission among Injecting Drug Users in Bushwick, Brooklyn (USA)
Kirk Dombrowski (corresponding author)
Samuel R. Friedman
Recent interest by physicists in social networks and disease transmission factors has prompted debate over the topology of degree distributions in sexual networks. Social network researchers have been critical of ‘scale-free’ Barabasi-Albert approaches, and largely rejected the preferential attachment, ‘rich-get-richer’ assumptions that underlie that model. Instead, research on sexual networks has pointed to the importance of homophily and local sexual norms in dictating degree distributions, and thus disease transmission thresholds. Injecting Drug User Network topologies may differ from the emerging models of sexual networks, however. Degree distribution analysis of a Brooklyn, NY, IDU network indicates a different topology than the spanning tree configurations discussed for sexual networks, instead featuring comparatively short cycles and high concurrency. Our findings suggest that IDU networks do in some ways conform to a “scale-free” topology, and thus may represent “reservoirs” of potential infection despite seemingly low transmission thresholds.
Keywords: Social Network Analysis, Injecting Drug Users, Scale-Free Networks
During 2012, the NYC National Behavioral Surveillance (NHBS) NYC team will recruit 500 New Yorkers who inject drugs, interview them about HIV risk and protective behaviors, and HIV testing history, and test them for HIV. As in past studies the team has conducted with NYC injection drug users (IDU), NHBS-IDU3 will use Respondent Driven Sampling to recruit the study sample, taking advantage of peer networks both to recruit study participants, and gain understanding of the network dynamics of HIV transmission in this high-risk population. The team recently received additional funds from the CDC to conduct Hepatitis B and C testing in conjunction with the main NYC NHBS-IDU3 study.
The team recently submitted a report to the CDC summarizing research about NYC IDU since the last such cycle in 2009. Of the 22 NYC IDU-related papers published from 2009-2011 identified through PubMed and Google Scholar searches, 5 were NHBS-based papers by the team, with another 6 by team members collaborating with others on other datasets.
The NYC NHBS team recently completed all data cleaning on the interview data from the 508 NYC MSM recruited during the 2011 recruiting cycle. Analysis and write-up will now get underway.
Modeling Dynamic Risk Networks
We describe a general framework for stochastic actor-based modeling of real-world dynamic risk networks. The models capture heterogeneity in the types of individuals, their interconnecting risk relationships, and the pathogens flowing between them. Dynamism is supported through arrival and departure processes, continuous restructuring of risk relationships, and changes to the pathogen over its lifetime. Whenever possible, the system is regulated through constraints on the local agency of individual nodes, risk relationships, and pathogen flows, rather than by system-wide specifications. We illustrate the application of the framework by applying it to a case study of HIV prevalence in injecting drug user (IDU) networks in New York City.
Khan, Dombrowski, Saad