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“摇头丸和STD/HIV风险在使用摇头丸的年轻人中隐藏的网络”，将调查在哈特福德，CT地区的易受伤害的年轻人（18-25岁）中摇头丸和性冒险的相互作用，该州的STD/HIV感染率最高，MDMA的分布和使用也很普遍。目的是：(1)通过对目标人群中的50名青年进行焦点小组调查，确定MDMA与性风险之间的文化情景（情境条件、行为序列和解释主题）；(2)通过对120名参与者(男性和女性各占50%，按种族（拉丁裔、非裔美国人和欧美裔美国人）进行深入访谈，记录MDMA与危险性行为相关的药物史和近期涉及无保护和有保护的插入性行为的事件；(3)利用主题、定性比较分析和人种学决策模型来分析事件，确定MDMA对无保护性行为的独特贡献和导致这一结果的决策；(4)将文化情景与人际脚本进行比较，以证明在涉及MDMA和性冒险的现有文化剧目中添加现实生活解决方案的重要性；(5)根据研究结果，与青年、服务提供者、媒体等青年文化意见领袖、教育工作者和政策制定者进行焦点小组讨论，确定多层次干预方法。本研究以脚本理论为指导。本研究采用的定性分析方法的独特组合解决了定量研究人员面临的问题，迄今为止，定量研究人员的发现在确定酒精、大麻和MDMA等物质与无保护的性行为和其他性风险之间的因果关系方面尚无定论。使用集合理论和布尔逻辑，定性比较分析提供了方程，分离出单一药物（如MDMA）在其他药物使用和其他因素的背景下对性风险的独特贡献。该研究还解决了脚本研究的局限性，脚本研究假设基于文化情景的行为模式，未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防止MDMA和性冒险发生的特定情况。因此，该提案直接解决了MDMA（与或不与其他药物一起使用）可能增加性风险行为从而促进性病/艾滋病毒传播的公共卫生问题；它还解决了与确定药物使用与危险性行为之间的关系有关的尚未解决的方法问题，这对解决这一问题的其他公共卫生办法具有影响。

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.