MDMA and STI/HIV Risk in Hidden Networks of Young Adult Ecstasy-Users

描述(由申请人提供)：这项为期三年的定性研究题为“摇头丸使用的隐藏网络中的摇头丸和性病/艾滋病毒风险”，将调查康涅狄格州哈特福德地区脆弱的年轻人(18-25岁)摇头丸和性风险之间的相互作用，该地区的性病/艾滋病毒感染率在该州最高，MDMA的分布和使用很普遍。目的是：(1)通过与目标人群中的50名青年的焦点小组，确定将MDMA和性风险联系起来的文化情景(背景条件、行为顺序和解释性主题)；(2)通过深入访谈毒品历史和最近发生的涉及使用和不使用MDMA的无保护和受保护的渗透性行为的事件，记录MDMA在危险性行为中的作用；120名参与者(50%为男性和女性，按种族(拉丁裔、非裔美国人和欧洲裔美国人)平分)；(3)利用专题、定性比较分析和民族志决策模型分析事件，并确定MDMA对无保护的性行为的独特贡献以及导致这一结果的决策；(4)将文化情景与人际剧本进行比较，以证明在涉及MDMA和性冒险的现有文化剧目中加入现实生活解决方案的重要性；以及(5)根据研究结果，与青年、服务提供者、媒体和其他青年文化舆论领袖、教育工作者和政策制定者开展焦点小组，以确定多层次的干预方法。本研究以脚本理论为指导。这项研究采用了独特的定性分析方法组合，解决了定量研究人员面临的问题，他们的研究结果迄今在确定酒精、大麻和摇头丸等物质与无保护措施的性行为和其他性风险之间的因果联系方面尚无定论。利用集合论和布尔逻辑，定性比较分析提供了公式，在其他药物使用和其他促成因素的背景下，分离出诸如MDMA等单一药物对性风险的独特贡献。这项研究还指出了脚本研究的局限性，这些研究假设基于文化情景的行为模式，而不能探索人们生活经验和实践的全部范围。通过这样做，这项研究有望找到新的方法来预防MDMA和性风险行为发生的特定情况。因此，该提案直接解决了公众对MDMA(使用和不使用其他药物)可能增加促进性病/艾滋病毒传播的性危险行为的公共卫生关切；它还解决了与确定物质使用和危险性行为之间的关系有关的尚未解决的方法学问题，这对解决这一问题的其他公共卫生办法有影响。

DESCRIPTION (provided by applicant): This three-year qualitative study entitled, "MDMA and STD/HIV risk among hidden networks of ecstasy-using young adults," will investigate the interaction of ecstasy and sexual risk-taking among vulnerable young adults (ages 18-25) in the Hartford, CT region where STD/HIV rates are highest in the state and MDMA distribution and use are widespread. Aims are: (1) Identify cultural scenarios (contextual conditions, behavioral sequences and explanatory themes) that link MDMA and sexual risk through focus groups with 50 youth in the target population; (2) document the role of MDMA in relation to risky sex through in depth- interviews on drug histories and recent events involving unprotected and protected penetrative sex, with and without MDMA use, with 120 participants (50% male and female, and equally divided by ethnicity (Latino, African American and Euro-American); (3) utilize thematic, Qualitative Comparative Analysis and Ethnographic Decision Modeling to analyze the events and determine the unique contribution of MDMA to unprotected sex and the decision making that results in this outcome; (4) compare cultural scenarios against interpersonal scripts to demonstrate the importance of adding real-life solutions to existing cultural repertoires involving MDMA and sexual risk-taking; and (5) conduct focus groups with youth, service providers, media and other youth cultural opinion leaders, educators and policy makers based on study results to identify multilevel intervention approaches. The study is guided by scripting theory. The unique combination of qualitative analytic methodologies employed in this study addresses problems confronted by quantitative researchers, whose findings have thus far been inconclusive with respect to establishing causal links between substances including alcohol, marijuana and MDMA, and unprotected sex and other sexual risks. Using set theory and Boolean logic, Qualitative Comparative Analysis offers equations that isolate the unique contributions of single drugs such as MDMA to sexual risks in the context of other drug use and other contributing factors. The study also addresses the limitations of scripting studies which assume behavioral patterns based on cultural scenarios and fail to explore the full range of people's lived experience and practices. By doing so, this study promises to find new approaches to preventing the specific circumstances under which MDMA and sexual risk-taking occur. The proposal thus addresses directly the public health concern that MDMA (with and without other drugs) may increase sexual risk behaviors that facilitate transmission of STDs/HIV; it also addresses as yet unsolved methodological problems associated with determining the relationships between substance use and risky sex, which has implications for other public health approaches to this problem.