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这两大流行病笼罩了许多新兴国家。受影响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（IDUs）中的艾滋病毒流行率迅速扩大，特别是在两国边境附近的一些城市。在俄罗斯圣彼得堡，过去十年中，注射吸毒者中的艾滋病毒感染率从2%上升到43%；在爱沙尼亚Kohtla-Jarve，注射吸毒者的流行率在本十年中从接近零增加到近70%。随着感染流行率的增加，越来越迫切需要提供艾滋病毒预防、艾滋病毒检测和咨询、艾滋病毒医疗保健以及对使注射吸毒者面临感染或传播艾滋病毒风险的毒瘾的治疗。然而，获得这些服务受到社会因素的影响，其中包括种族地位和耻辱，主要表现在三方面：对注射吸毒者、对艾滋病毒感染者和艾滋病患者以及对非占主导地位的族裔群体。我们正在提议进行一项研究，以确定种族和耻辱对圣彼得堡和Kohtla-Jarve的艾滋病毒流行和获得护理的影响。我们将从快速政策评估开始，使我们能够更好地了解预防和护理系统是如何组织起来的，以及注射吸毒者对获得这些服务的感受。我们将在此基础上进行进一步的探索，以了解每个城市中来自优势和非优势族裔的注射吸毒者所感知的耻辱的三个方面的本质。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。首先，种族是艾滋病毒流行和获得预防和护理的独立预测指标；在圣彼得堡，不论不安全注射或无保护的性行为的数量不同，少数民族的成员将与较高的艾滋病毒流行率有关，而在Kohtla-Jarve，尽管大多数人口是俄罗斯民族，因为政治上占主导地位的民族是爱沙尼亚人；无论不安全注射或无保护性行为的数量不同，俄罗斯多数民族的成员将再次与较高的艾滋病毒流行率相关。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，感知到的耻辱与更高的艾滋病毒流行率和更少的服务机会有关，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原假设。

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.