大衰退余震的严重程度是否与注射毒品者获得综合预防环境的变化相关？
Is the severity of the Great Recession's aftershocks correlated with changes in access to the combined prevention environment among people who inject drugs?
机构信息
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
出版信息
Int J Drug Policy. 2021 Sep;95:103264. doi: 10.1016/j.drugpo.2021.103264. Epub 2021 May 11.
BACKGROUND
The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States.
METHODS
The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012.
RESULTS
675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents.
CONCLUSION
Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
背景
2008 年的经济衰退是一场全球性事件，导致美国的项目和服务资金削减；尽管这场衰退已于 2009 年正式结束，但它的余波一直持续到 2012 年。我们评估了大衰退余波的严重程度与居住在美国 19 个都会统计区（MSA）的注射吸毒者（PWID）获得综合预防服务（即 HIV 检测、注射器服务项目、物质使用障碍治疗项目）的空间可达性之间的关系。
方法
分析单位是邮政编码；我们根据疾病预防控制中心的国家 HIV 行为监测，在这 19 个 MSA 中抽样了 2009 年和 2012 年至少有 1 名 PWID 居住的邮政编码。我们使用行政数据描述每个邮政编码的综合预防环境（即 HIV 检测的空间可达性），并测量每个邮政编码、所在县和 MSA 中经济衰退余波的严重程度。多层次模型估计了 2009 年至 2012 年大衰退余波变化与邮政编码层面获得综合预防服务空间可达性变化之间的关联。
结果
这项分析包括位于 36 个县和 19 个 MSA 的 675 个邮政编码。从 2009 年到 2012 年，21%的邮政编码地区失去了获得综合预防服务的机会，而 14%的地区获得了机会。相对于各自的 MSA，贫困率较高的邮政编码获得服务的机会较少（OR：0.91；95%CI：0.88，0.95），获得服务的机会更多（OR：1.05；95%CI：1.01，1.09）；有一些证据表明，前者的关联在非西班牙裔白人居民比例较高的邮政编码中减弱了。
结论
居住在这 675 个邮政编码中的 PWID 的综合预防服务在大衰退的余波中表现出了韧性。未来的研究应该探讨社区和联邦艾滋病毒预防计划是否有助于这种韧性，特别是在有色人种集中的地区。
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