Barriers to Treatment-based HIV Prevention for IDU Couples

描述(申请人提供)：尽管最近在艾滋病毒预防方面取得了进展，但在美国，注射吸毒者(IDU)仍占新感染病例的三分之一。注射吸毒方面的种族/族裔差异也继续在少数族裔和妇女中造成不成比例的新艾滋病毒病例。这项建议针对的是弱势和未得到充分研究的注射吸毒者群体--少数民族、异性恋、注射吸毒者夫妇(即结伴注射吸毒者)。虽然对伴侣注射吸毒者的研究很少，但现有文献表明，伴侣注射吸毒者因与毒品有关的行为和性危险行为而感染艾滋病毒的风险很高。结伴注射吸毒者，特别是结伴女性注射吸毒者，在减少药物使用、获得或完成药物滥用治疗以及维持治疗结果(减少药物使用、更安全的药物使用做法、更安全的性行为)方面也取得了有限的成功。这种结伴注射吸毒者的情况对以治疗为基础的艾滋病毒预防具有重要影响。药物滥用治疗是降低注射吸毒者中与药物和性有关的艾滋病毒风险的有效方法。NIDA最近的一份出版物得出结论说，“药物滥用治疗是艾滋病毒的预防。”然而，在美国，接受治疗的注射吸毒者的比例中值非常低--不到9%。显然，除非更多的注射吸毒者接受治疗，否则无法实现艾滋病毒预防的全部效果。由于相当数量的注射吸毒者与其他注射吸毒者有性伴侣(根据我们自己的纽约市数据，超过40%)，了解和克服伴侣注射吸毒者成功治疗和以治疗为基础的艾滋病毒预防的障碍将对减少药物使用和艾滋病毒风险产生重大影响，特别是在少数族裔妇女中。这项对注射吸毒者夫妇和治疗提供者的定性研究集中在纽约市非裔美国人和拉丁裔异性恋者注射吸毒者夫妇中药物治疗和基于治疗的艾滋病毒风险降低的两组障碍：(1)伴侣注射吸毒者之间的关系动态，阻碍了治疗进入、保留或维持结果；(2)治疗系统中针对夫妇的结构性障碍，进一步抑制了治疗进入、保留和维持结果。我们还对(3)这两种壁垒如何相互作用感兴趣。拟议研究的结果将为量化这些障碍以及制定和评估克服这些障碍的计划的后续工作提供信息。这项研究是由一位新的研究人员提出的，并利用了R-21机制。公共卫生声明注射吸毒者中艾滋病毒的传播仍然是一个重要的公共卫生问题。尽管最近在艾滋病毒预防方面取得了进展，但美国注射吸毒者仍占所有新感染病例的三分之一。注射毒品使用方面的种族/族裔差异也继续造成不成比例的感染。这项拟议的研究主要针对在亲密关系中有伴侣的非洲裔美国人和拉丁裔注射吸毒者。虽然对伴侣注射吸毒者的研究很少，但现有的文献表明，他们因与毒品有关的行为和性危险行为而感染艾滋病毒的风险很高。此外，它们在减少药物使用、获得或完成药物滥用治疗和维持治疗结果(减少药物使用、更安全的药物使用做法、更安全的性行为)方面取得的成功有限。拟议的研究将有助于了解药物治疗和以治疗为媒介的艾滋病毒预防工作中的人际和结构性障碍，并提出必要的改进建议。

DESCRIPTION (provided by applicant): Despite recent advances in HIV prevention, injecting drug users (IDUs) in the U.S. still account for 1/3 of new infections. Racial/ethnic disparities in injection drug use also continue to cause a disproportionate share of new HIV cases among minorities and women. This proposal targets a vulnerable and understudied population of IDUs - minority, heterosexual, IDU couples (i.e. partnered IDUs). While research on partnered IDUs is scarce, existing literature indicates that partnered IDUs are at high risk for HIV from both drug- related and sexual risk behaviors. Partnered IDUs, especially partnered women IDUs, also have limited success in reducing drug use, accessing or completing drug abuse treatment, and maintaining treatment outcomes (reduced drug use, safer drug-use practices, safer sex). This profile of partnered IDUs has important implications for treatment-based HIV prevention. Drug abuse treatment is an effective method for reducing drug-and sex-related HIV risk among IDUs. A recent NIDA publication concludes that "drug abuse treatment is HIV prevention." However, the median proportion of IDUs who access treatment in the U.S. is extremely low - less than 9%. Clearly, the full efficacy of HIV prevention cannot be realized unless more IDUs enter treatment. Since a substantial number of IDUs are sexually partnered with other IDUs (more than 40%, according to out own NYC data), understanding and overcoming barriers to successful treatment and treatment-based HIV prevention among partnered IDUs will have a substantial impact on reducing drug use and HIV risk, especially among minority women. This qualitative study of IDU couples and treatment providers focuses on two sets of barriers to drug treatment and treatment-based HIV risk reduction among African American and Latino heterosexual IDU couples in NYC: (1) relationship dynamics among partnered IDUs that deter treatment entry, retention or the maintenance of outcomes; and (2) couples-specific structural barriers in the treatment system that further inhibit treatment entry, retention, and the maintenance of outcomes. We are also interested in (3) how these two kinds of barriers interact. Findings from the proposed research will inform subsequent work to quantify these barriers and develop and evaluate programs to overcome them. This study is proposed by a new investigator and utilizes the R-21 mechanism. PUBLIC HEALTH STATEMENT HIV transmission among injection drug users (IDUs) continues to be an important public health issue. Despite recent advances in HIV prevention, injection drug users in the U.S. still account for 1/3 of all new infections. Racial/ethnic disparities in injection drug use also continue to cause a disproportionate share of infections. The proposed study primarily targets African American and Latino IDUs who are partnered in intimate relationships. While research on partnered IDUs is scarce, existing literature indicates that they are at high risk for HIV from both drug-related and sexual risk behaviors. In addition, they have limited success in reducing drug use, accessing or completing drug abuse treatment and maintaining treatment outcomes (reduced drug use, safer drug use practices, safer sex). The proposed study will contribute to an understanding of interpersonal and structural barriers to drug treatment and treatment-mediated HIV prevention and lead to recommendations for needed improvements.