Reducing Intersectional and HIV Stigma among High Risk Women who use Drugs in Kazakhstan, Central Asia: A Multilevel Stigma Resistance and Enacted Stigma Reduction Intervention for Women and Providers

减少哈萨克斯坦和中亚吸毒高危女性的交叉耻辱和艾滋病毒耻辱：多层次的耻辱抵抗和针对妇女和服务提供者实施的减少耻辱干预措施

• 批准号: 10542972
• 负责人: Victoria Frye
• 金额: $ 26.66万
• 依托单位: COLUMBIA UNIV NEW YORK MORNINGSIDE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542972
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Advocacy; Amelia; Appointment; Attitude; Awareness; Belief; Caring; Central Asia; Cessation of life; Client; Clinic; Communicable Diseases; Communities; Continuity of Patient Care; Country; Data; Dermatology; Drug usage; Drug user; Focus Groups; Future; Goals; HIV; HIV Infections; HIV/STD; Health Personnel; Healthcare; High Risk Woman; Human immunodeficiency virus test; Incidence; Income; Infection; Injecting drug user; Intervention; Kazakhstan; Media Campaign; Methods; Multimedia; Online Systems; Outcome; Persons; Pharmaceutical Preparations; Population; Population Intervention; Pre-Post Tests; Prevalence; Prevention; Provider; Public Health; Research; Research Infrastructure; Resistance; Resources; Risk; Sex Discrimination; Sexual Health; Sexual Partners; Source; Stereotyping; Stigmatization; Testing; Training; Training Programs; Viral; Visit; Vulnerable Populations; Woman; Work; acceptability and feasibility; antiretroviral therapy; arm; coping; crowdsourcing; design; effectiveness trial; evidence base; experience; female sex worker; follow-up; health assessment; health goals; improved; innovation; internalized stigma; low and middle-income countries; pilot test; post implementation; pre-exposure prophylaxis; primary outcome; resilience; response; secondary outcome; self testing; sex; social stigma; stem; success; therapy design; uptake; usability

ABSTRACT Suboptimal linkage to and retention in HIV prevention and care is prevalent among high risk women who use or inject drugs in both the US and globally, stemming, in part, from high levels of stigma. In Kazakhstan, increasing engagement in the HIV care and prevention continuum is a major public health goal, as the number of new HIV infections doubled from 2010 to 2017 and AIDS-related deaths increased by 32%. Among high risk women who use drugs in this context, our research has found that ~30% are HIV-infected and that they are less likely to test and receive care. Numerous studies have documented that experienced, anticipated and internalized stigma, especially from health care providers (HCP), are key barriers to HIV testing and treatment in global contexts. For high risk women who use drugs, HIV and associated stigmas, specifically stigma related to sex and drug use, as well as gender discrimination, work independently and synergistically to inhibit access to HIV prevention and treatment; yet, there are no existing anti-stigma interventions designed and tested in Kazakhstan for this key population of women and that focus on HCP as sources of stigma. Here we propose to design and assess acceptability, feasibility, and generate information in order to power a preliminary effectiveness trial of a three component, multi-level participatory intervention to reduce HIV-associated and intersectional stigma - and thus increase access to HIV prevention and care. The first component is aimed at high risk women and designed to increase stigma resistance/coping and reduce anticipated/internalized stigma via: a) crowdsourcing of anti- stigma messaging for HCP; and b) adaptation of a HCP training for optimal sexual health and healthcare engagement among high risk women who used drugs. The second and third components, aimed at the HCP and other clinic staff and emerging from the execution of the first component, include: a) the resultant messaging campaign; and b) the training that will be delivered to HCP. Both the messaging campaign and the training components will be designed to reduce enacted stigma by HCP/staff (and thus experienced stigma among women) and increase stigma resistance and resilience among high risk women who use drugs. All components will work synergistically to reduce enacted, experienced and internalized, intersectional stigma. The approach relies on evidence-based methods, including media campaigns, to reduce HCP enacted stigma, and integrates innovative methods, like crowdsourcing and participatory research, to increase stigma resistance. Results of this study will be unique in utilizing multilevel anti-stigma approaches for both high risk women who use drugs and HCP and have important implications for advancing HIV prevention and care engagement among highly stigmatized populations globally and in the US.

抽象的 在使用或 在美国和全球注射药物，部分原因是高水平的污名。在哈萨克斯坦，不断增加 参与艾滋病毒护理和预防连续性是一个主要的公共卫生目标，因为新艾滋病毒的数量 从2010年到2017年，感染增加了一倍，与艾滋病相关的死亡增加了32％。在高风险女性中 在这种情况下，使用药物，我们的研究发现约有30％是感染了HIV的30％，并且它们不太可能进行测试 并得到护理。许多研究表明，经验丰富，预期和内在的污名， 尤其是医疗保健提供者（HCP），是在全球环境下艾滋病毒测试和治疗的关键障碍。为了 使用药物，艾滋病毒和相关污名的高风险妇女，特别是与性和吸毒有关的污名， 以及性别歧视，独立和协同工作，以抑制获得艾滋病毒的机会和 治疗;但是，在哈萨克斯坦没有现有的抗污名干预措施为此钥匙 妇女的人口以及专注于HCP作为污名来源。在这里，我们建议设计和评估 可接受性，可行性和生成信息，以便为三个的初步有效性试验提供动力 组成部分，多层参与式干预措施，以减少艾滋病毒相关和交叉污名 - 因此 增加获得艾滋病毒预防和护理的机会。第一个组成部分的目的是高风险女性，旨在 通过以下方式增加污名/应对的污名/应对，并减少预期/内在的污名 HCP的污名消息传递； b）适应最佳性健康和医疗保健的HCP培训 在使用毒品的高风险妇女中参与。针对HCP的第二组和第三个组件 以及其他诊所工作人员，以及第一个组件的执行，包括：a）结果消息传递 活动; b）将交付给HCP的培训。消息传递活动和培训 组件将旨在减少HCP/工作人员的构成污名（因此 妇女）并增加使用药物的高风险女性的抗污名和韧性。所有组件 将协同作用，以减少颁布，经验丰富和内在的交叉污名。方法 依靠基于证据的方法，包括媒体活动，以减少HCP制定污名并整合 创新方法，例如众包和参与性研究，以增加污名化。结果 研究将在使用使用药物和使用药物的高风险女性的多层次抗污名方法方面独一无二 高度 全球和美国的污名人群。