Funded Pilots

People who use drugs (PWUD) face disproportionately high sexually transmitted infections (STIs) due to intersecting behavioral, social, and structural risks, yet most studies examine these factors in isolation. Understanding how multi-level influences converge is critical to designing scalable, equity-focused prevention strategies.

This pilot project will integrate national survey data with a local intervention trial to advance knowledge of disparities, phenotypes, and place-based drivers of STI risk among PWUD. Using National Survey on Drug Use and Health (NSDUH) data, the study will quantify disparities across socioeconomic and demographic gradients, identify multi-level “risk phenotypes” through latent class analysis, and generate small-area estimates of geographic variation. It will then test the feasibility and transportability of these findings in the Community Wise optimization trial of formerly incarcerated men with substance use disorder. Analyses will validate whether NSDUH-derived phenotypes replicate in this high-risk cohort and examine heterogeneous treatment effects to determine which subgroups benefit most from intervention participation. Finally, it  will synthesize findings to develop an environmentally grounded conceptual framework linking individual, relational, and community-level factors to STI outcomes among PWUD.

The result will help to inform scalable approaches to reduce STI and HIV disparities among PWUD.

This pilot will provide proof-of-concept findings and an analytic approach for a life-course analytic framework that triangulates findings from three national datasets: the National Vital Statistics System – Mortality Statistics (NVSS), National Survey on Drug Use and Health (NSDUH), and Monitoring the Future (MTF).

It will examine cardiovascular disease and comorbidities among decedents who had HIV and used drugs from the NVSS dataset, then assess whether living adults in the NSDUH sample have comparable co-occurrence with those in the NVSS dataset, as well as identifying associated substance use risk patterns, risk, and protective factors. Finally, it will determine whether there are early signals co-occurrence in youth from Monitoring the Future data.

The stepwise analytic approach will assist in uncovering patterns in mortalities, validates them, and then contextualizes them across life stages. Findings from this proposal can guide more precise and population-specific strategies to improve health outcomes for people living with HIV.

The study addresses critical gaps in understanding the role of new and emerging social networks—particularly digital platforms such as Grindr, TikTok, Snapchat, Instagram, and X (formerly Twitter)—in shaping cannabis and other substance use behaviors, mental health outcomes (e.g., anxiety), and HIV risk in New York City.

This project will conduct formative research to develop a peer-driven, community-based, culturally-appropriate and contextually-relevant approach that will systematically incorporate Latinx people who sell drugs into public health research and intervention activities.