STRIDES (Strategies To Reduce Intersectional Drug usE Stigma): A mixed-methods, human-centered approach to address barriers to HIV services

项目摘要/摘要 美国南部与吸毒有关的艾滋病毒传播比例比任何其他美国都要高 该地区和非洲裔美国人受到的影响不成比例。吸毒耻辱是一个重要的障碍 在艾滋病毒预防和护理连续体的每个阶段参与和保留。与艾滋病毒相关的耻辱- 医疗保健环境中的减少干预措施已显示出积极的结果、可行性和可接受性 美国和全球都是如此。然而，这些干预措施几乎没有解决药物使用耻辱的问题。因此，有一个 迫切需要了解吸毒污名如何影响艾滋病毒服务的参与度和保留率 非裔美国人使用毒品，并制定有针对性的干预措施和方案，以减少毒品使用 耻辱。如果不能阐明和积极解决吸毒耻辱问题，将导致耻辱继续成为阻碍 为关键人群和美国受艾滋病毒影响最严重的地区提供艾滋病毒服务。 长期目标是开发一种基于证据的药物使用耻辱减少干预措施，该干预措施可以 在艾滋病毒服务中实施，并最终减少艾滋病毒预防和护理中的种族差异 连续体。拟议项目的总体目标是使用混合方法来阐明如何 与毒品有关的污名影响艾滋病毒服务的参与度和保留率，并利用这些调查结果选择， 适应和预先测试一种循证的艾滋病毒污名减少干预措施，以解决吸毒污名和 其他相互交错的柱头形式。 具体目标是： 目的1.进行混合方法研究以评估和检查人类服务中的药物使用污名 在吸毒者和卫生诊所工作人员中的环境。 目标2.选择和调整循证的艾滋病毒污名课程，以减少药物使用污名和 消除歧视，增加/改善艾滋病毒预防和护理的参与度和留存率 在吸毒者中的连续体。 目的3.对适应后的减少污名和歧视课程进行预测，以进行初步评估 可接受性和可行性。 这项研究具有创新性，因为它将通过以下方式改变目前关于药物使用耻辱的研究范式 使用以人为中心和地位中立的办法。拟议的形成性研究将为 为随后的研究奠定基础，以测试量身定制的药物使用的有效性和初步影响 减少污名的干预措施。这项研究与美国国立卫生研究院艾滋病毒/艾滋病报告中确定的高度优先领域相一致 研究优先事项，特别是最终减少艾滋病毒发病率的健康差距的研究。

PROJECT SUMMARY/ABSTRACT The US South has a greater proportion of HIV transmission associated with drug use than any other US region, and African Americans are disproportionately affected. Drug use stigma is a significant barrier to engagement and retention at every stage of the HIV prevention and care continuum. HIV-related stigma- reduction interventions in healthcare settings have shown positive outcomes, feasibility, and acceptability in the US and globally. However, few of these interventions address drug use stigma. Consequently, there is a critical need to understand how drug use stigma impacts engagement and retention in HIV services for African Americans who use drugs and to develop targeted interventions and programs to reduce drug use stigma. Failing to elucidate and actively address drug use stigma will result in stigma remaining a barrier to HIV services for a key population and in the region most affected by HIV in the US. The long-term goal is to develop an evidence-based drug use stigma-reduction intervention that can be implemented in HIV services, and ultimately reduce racial disparities in the HIV prevention and care continuum. The overarching objective for the proposed project is to use mixed methods to elucidate how drug-related stigma impacts engagement and retention in HIV services and use these findings to select, adapt, and pretest an evidence-informed HIV stigma-reduction intervention to address drug use stigma and other intersecting forms of stigma. The Specific Aims are: Aim 1. To conduct mixed methods research to assess and examine drug use stigma in human service settings among people who use drugs and health clinic staff. Aim 2. To select and adapt an evidence-informed HIV stigma curriculum to reduce drug use stigma and discrimination and to increase/improve engagement and retention in the HIV prevention and care continuum among people who use drugs. Aim 3. To pretest the adapted stigma and discrimination reduction curriculum to evaluate preliminary acceptability and feasibility. This research is innovative because it will shift current research paradigms regarding drug use stigma via the use of human-centered and status-neutral approaches. The proposed formative research will lay the groundwork for subsequent research to test the efficacy and preliminary impact of the tailored drug use stigma-reduction intervention. This study aligns with the high-priority areas identified in the NIH HIV/AIDS Research Priorities, specifically research to ultimately reduce health disparities in HIV incidence.