Faculty Bibliography

The term "Big Events" began as a way to help understand how wars, transitions and other crises shape long-term HIV epidemiology in affected areas. It directs attention to the roles of ordinary people in shaping these outcomes. Big Events themselves can take years, as in long-term armed struggles like those in Colombia and also long-term political and economic changes like the turn over the last 15 years of many Latin American countries away from neoliberalism and towards attempts to build solidarity economies of some form. The effects of Big Events on HIV epidemics, at least, may run in phases: In the short term, by creating vulnerability to epidemic outbreaks among existing Key Populations like people who inject drugs (PWID) or men who have sex with men (MSM); then, in their non-PWID (or non-MSM) risk networks; and perhaps, several years later, among youth who became involved in high-risk sexual or drug use networks and behaviors due to the social impacts of the Big Event. Issues of time loom large in other articles in this Special Issue as well. Some articles and commentaries in this issue point to another important phenomenon that should be studied more: The positive contributions that people who use drugs and other members of the population make towards helping other people in their communities during and after Big Events. Finally, this Commentary calls for more thought and research about an impending very Big Event, global climate change, and how it may exacerbate HIV, hepatitis C and other epidemics among people who use drugs and other members of their networks and communities.

The altruism and/or solidarity of people who inject drugs helps protect sex and drug partners from HIV. Research has been hindered by lack of measures. We developed and administered scales to assess them to 300 people who inject drugs. Altruism and Solidarity Scales were both internally consistent. Each correlated significantly with measures of helping others. These measures appear reliable and valid. They can be used to study how big events or structural interventions affect altruism and solidarity, and how altruism and solidarity are associated with changes in HIV or other risks, among people who inject drugs.

Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.

OBJECTIVES/OBJECTIVE:We estimated race/ethnicity-specific incident AIDS diagnosis rates (IARs) among people who inject drugs (PWID) in U.S. metropolitan statistical areas (MSAs) over time to assess the change in disparities after highly active antiretroviral therapy (HAART) dissemination. METHODS:We compared IARs and 95% confidence intervals (CIs) for black/African American and Hispanic/Latino PWID with those of white PWID in 93 of the most populous MSAs. We selected two three-year periods from the years immediately preceding HAART (1993-1995) and the years with the most recent available data (2005-2007). To maximize stability, we aggregated data across three-year periods, and we aggregated data for black/African American and Hispanic/Latino PWID for most comparisons with data for white PWID. We assessed disparities by comparing IAR 95% CIs for overlap. RESULTS:IARs were significantly higher for black/African American and Hispanic/Latino PWID than for white PWID in 81% of MSAs in 1993-1995 and 77% of MSAs in 2005-2007. MSAs where disparities became non-significant over time were concentrated in the West. Significant differences were more frequent in comparisons between black/African American and white PWID (85% of MSAs in 1993-1995, 79% of MSAs in 2005-2007) than in comparisons between Hispanic/Latino and white PWID (53% of MSAs in 1993-1995, 56% of MSAs in 2005-2007). IARs declined modestly across racial/ethnic groups in most MSAs. CONCLUSIONS:AIDS diagnosis rates continue to be substantially higher for black/African American and Hispanic/Latino PWID than for white PWID in most large MSAs. This finding suggests a need for increased targeting of prevention and treatment programs, as well as research on MSA-level conditions that may serve to maintain the disparities.