Influences on HIV Prevalence and Service Access among IDUs in Russia and Estonia

对俄罗斯和爱沙尼亚注射吸毒者艾滋病毒感染率和服务获取的影响

• 批准号: 8511180
• 负责人: ROBERT HEIMER
• 金额: $ 35.65万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8511180
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Area; Caring; Cessation of life; Cities; Collaborations; Communities; Counseling; Country; Data Analyses; Data Collection; Drug Addiction; Drug abuse; Employee Strikes; Epidemic; Estonia; Ethnic Origin; Ethnic group; European; HIV; HIV Infections; HIV risk; Health; Health Psychology; Health Services Accessibility; Health Services Research; Healthcare Systems; Human immunodeficiency virus test; Infection; Injecting drug user; Injection of therapeutic agent; International; Life; Location; Measures; Medical; Methods; Minority; Nature; Policies; Population; Prevalence; Prevention; Reporting; Research; Research Personnel; Respondent; Risk; Role; Russia; Sampling; Services; Severities; Social Psychology; System; Testing; Twin Multiple Birth; USSR; Universities; Unsafe Sex; Viral; Work; addiction; burden of illness; care delivery; care systems; ethnic minority population; experience; injection drug use; instrument; meetings; prevent; prevention service; social; social stigma; substance abuse epidemiology; transmission process

DESCRIPTION (provided by applicant): Following the collapse of the Soviet Union twin epidemic of HIV and injection drug abuse enveloped many of the newly emerging countries. Among the countries hardest hit were Russia and Estonia. In both countries, HIV prevalence among injection drug users (IDUs) has expanded rapidly, especially in some cities that lie near the border of the two countries. In St. Petersburg, Russia, HIV prevalence among IDUs has increased from 2% to 43% over the past decade; in Kohtla-Jarve, Estonia, prevalence among IDUs has increased from near zero to nearly 70% this decade. With this increase in infection prevalence, there has grown a pressing need to provide HIV prevention, HIV testing and counseling, HIV medical care, and treatment for the drug addiction that places IDUs at risk for acquiring or transmitting HIV. However, access to these services is compromised by social factors that include ethnic status and stigma directed in up to three ways: towards IDUs, towards those living with HIV infection and AIDS, and towards those of the non-dominant ethnic group. We are proposing a study to ascertain the impacts of ethnicity and stigma on HIV prevalence and on access to care in St. Petersburg and Kohtla-Jarve. We will begin with a rapid policy assessment that allows us to better understand how systems of prevention and care are organized and how IDUs feel about accessing these services. We will follow this with further explorations to understand the nature of the three facets of stigma as perceived by IDUs from the dominant and non-dominant ethnic groups in each city. Lastly, we will conduct a quantitative study to test hypotheses about the impacts of ethnicity and stigma on HIV prevalence and access to prevention and care services. We will test three major hypotheses. The first is that ethnicity is an independent predictor of HIV prevalence, and access to prevention and care; that in St. Petersburg, membership in an ethnic minority will be associated with higher HIV prevalence irrespective of differences in the amount of unsafe injection or unprotected sex while in Kohtla-Jarve, although the majority of the population is of Russian ethnicity, because the politically dominant ethnic group is Estonian, membership in the ethnic Russian majority will be associated with higher HIV prevalence again irrespective of differences in the amount of unsafe injection or unprotected sex. The second hypothesis is that the non-dominant ethnic group in each city will have less access to HIV prevention or medical services. The third hypothesis is that perceived stigma is associated with greater HIV prevalence and with less access to services while, conversely, we will not be able to reject the null hypothesis that ethnic stigma is associated with levels of HIV risk.

描述(申请人提供)：苏联解体后，艾滋病毒和注射毒品的双重流行笼罩着许多新兴国家。受影响最严重的国家包括俄罗斯和爱沙尼亚。在这两个国家，注射吸毒者中的艾滋病毒流行率迅速扩大，特别是在靠近两国边境的一些城市。在俄罗斯圣彼得堡，注射吸毒者的艾滋病毒流行率在过去十年中从2%上升到43%；在爱沙尼亚的Kohtla-Jarve，注射吸毒者的流行率在这十年中从几乎为零上升到近70%。随着感染流行率的增加，迫切需要提供艾滋病毒预防、艾滋病毒检测和咨询、艾滋病毒医疗护理以及使注射吸毒者面临感染或传播艾滋病毒风险的药物成瘾治疗。然而，获得这些服务的机会受到包括族裔地位和耻辱在内的社会因素的影响，这些因素以三种方式受到影响：针对注射吸毒者、针对艾滋病毒感染者和艾滋病患者以及针对非主要族裔群体。我们提议进行一项研究，以确定族裔和耻辱对艾滋病毒流行率和在圣彼得堡和科赫特拉-贾夫获得护理的影响。我们将从快速的政策评估开始，使我们能够更好地了解预防和护理系统是如何组织的，以及注射吸毒者对获得这些服务的感受。在此之后，我们将进一步探索，以了解每个城市中占主导地位和非占主导地位的民族的注射吸毒者所感知的耻辱的三个方面的性质。最后，我们将进行一项量化研究，以检验关于种族和耻辱对艾滋病毒流行率和获得预防和护理服务的影响的假设。我们将检验三个主要假设。第一，族裔是艾滋病毒流行率以及获得预防和护理的独立预测因素；在圣彼得堡，少数民族成员将与艾滋病毒感染率高相关，而在Kohtla-Jarve，无论不安全注射或无保护性行为的数量有多大，尽管人口多数是俄罗斯族裔，因为政治上占主导地位的族裔群体是爱沙尼亚人，所以无论不安全注射或无保护性行为的数量有多大，少数族裔的成员也将再次与艾滋病毒感染率高相关。第二种假设是，每个城市的非主要族裔群体获得艾滋病毒预防或医疗服务的机会将会减少。第三种假设是，感觉到的耻辱与更高的艾滋病毒流行率和更少获得服务的机会有关，而相反，我们将无法拒绝种族耻辱与艾滋病毒风险水平相关的无效假设。