Bowen Elizabeth A
a School of Social Work, University at Buffalo, State University of New York , Buffalo , New York , USA.
Soc Work Public Health. 2016 Jul;31(4):264-75. doi: 10.1080/19371918.2015.1137511. Epub 2016 Apr 19.
Elevated HIV prevalence has been observed among urban U.S. individuals who use drugs and who lack stable housing. This article synthesizes extant research on this population and situates it in a multilevel, ecologically based model of HIV risk. Based on a multidisciplinary review of the literature, the model applies social-ecological theory on human development to identify factors shaping the HIV risk context for individuals who use drugs and who are unstably housed at global, societal, neighborhood, household, and individual levels of influence. At the global level, the model includes neoliberal ideologies contributing to the social inequalities that frame the HIV epidemic. U.S. housing and drug policy, including urban renewal, HOPE VI, and the War on Drugs, is the focus of the societal level. At the neighborhood level, mechanisms of the built environment and psychosocial mechanisms are explored for their salience to HIV risk. Research on the association between housing instability and HIV risk is reviewed at the household level. At the last level, relevant individual differences in biology, psychology, and cognition are discussed. Modeling risk at multiple levels of the environment underscores the need to expand the focus of research, treatment, and prevention interventions for HIV/AIDS and addictions beyond individuals and their risk behaviors to address facets of structural violence and incorporate the broader social, political, and economic contexts of risk and health.
在美国城市中，吸毒且缺乏稳定住房的人群中，艾滋病毒感染率较高。本文综合了关于这一人群的现有研究，并将其置于一个基于生态的多层次艾滋病毒风险模型中。基于对文献的多学科综述，该模型应用人类发展的社会生态理论，以确定在全球、社会、社区、家庭和个人影响层面上，塑造吸毒且住房不稳定人群艾滋病毒风险背景的因素。在全球层面，该模型包括导致构成艾滋病毒流行的社会不平等的新自由主义意识形态。美国的住房和毒品政策，包括城市更新、希望六号计划和禁毒战争，是社会层面的重点。在社区层面，探讨建筑环境机制和心理社会机制对艾滋病毒风险的影响。在家庭层面，回顾住房不稳定与艾滋病毒风险之间关联的研究。在最后一个层面，讨论生物学、心理学和认知方面的相关个体差异。在环境的多个层面上对风险进行建模，强调有必要将艾滋病毒/艾滋病和成瘾问题的研究、治疗及预防干预的重点，从个体及其风险行为扩展到结构性暴力的各个方面，并纳入风险与健康的更广泛社会、政治和经济背景。
