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

描述（由申请人提供）：苏联解体后，艾滋病毒和注射吸毒的双重流行病笼罩了许多新兴国家。受灾最严重的国家是俄罗斯和爱沙尼亚。在这两个国家，注射吸毒者中的艾滋病毒流行率迅速上升，特别是在靠近两国边境的一些城市。在俄罗斯的彼得堡，注射吸毒者中的艾滋病毒流行率在过去十年中从2%上升到43%;在爱沙尼亚的科赫特拉-哈尔韦，注射吸毒者中的流行率在这十年中从接近零上升到近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对使注射吸毒者有感染或传播艾滋病毒风险的药物成瘾的治疗。然而，这些服务的获得受到社会因素的影响，这些因素包括种族地位和耻辱感，耻辱感在以下三个方面表现出来：注射吸毒者、艾滋病毒感染者和艾滋病患者以及非主要种族群体。我们提议进行一项研究，以确定族裔和耻辱对彼得堡和科赫特拉-哈尔韦艾滋病毒流行率和获得护理的影响。我们将开始迅速进行政策评估，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觉如何。我们将遵循这一进一步的探索，以了解的三个方面的耻辱的本质，认为注射吸毒者从占主导地位的和非占主导地位的种族群体在每个城市。最后，我们将进行一项定量研究，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。我们将测试三个主要假设。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;在彼得堡，无论不安全注射或无保护性行为的数量有多少，少数民族成员都与艾滋病毒感染率较高有关，而在科赫特拉-哈尔韦，尽管大多数人口是俄罗斯族，因为在政治上占主导地位的民族是爱沙尼亚族，无论不安全注射或无保护性行为的数量有多大差异，俄罗斯族多数民族的成员身份将再次与艾滋病毒感染率较高相关。第二个假设是，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较少。第三个假设是，所感受到的耻辱感与艾滋病毒流行率较高和获得服务的机会较少有关，而相反，我们将无法拒绝族裔耻辱感与艾滋病毒风险水平有关的零假设。

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.