Exploring Gendered Access to Drug and HIV Services to Improve Programs for Women

 描述（由申请人提供）：尽管艾滋病毒风险的性别性质得到广泛认可，但在全球范围内，妇女在艾滋病毒和药物治疗计划中的代表性不足。妇女比男子更不可能获得针头/注射器交换方案，获得和使用阿片类药物替代疗法的机会也更少。吸毒妇女在接受适当和必要的艾滋病毒和吸毒治疗和护理方面遇到与性别有关的障碍，包括耻辱和缺乏适当的服务。此外，吸毒妇女与艾滋病毒有关的风险与男子的风险不同。妇女面临与吸毒、性以及一系列个人、经济和社会因素有关的艾滋病毒风险。女性吸毒者还经常经历严重的贫困、经济依赖以及暴力和虐待，这限制了她们就关系和安全性行为进行谈判的能力。 世界卫生组织和联合国艾滋病规划署等机构已认识到，需要有针对性的预防、治疗和护理方案和服务;需要为吸毒者提供广泛的、方便的服务。为了制定全面的艾滋病毒预防战略，解决妇女易感染艾滋病毒的多重因素，首先必须了解 现有护理系统、服务差距以及艾滋病毒高危人群获得服务和与服务系统互动的方式。这项研究将对乌克兰妇女艾滋病毒和吸毒相关服务进行全面评估，以指导制定一项了解性别问题的综合服务战略，解决吸毒妇女与艾滋病毒有关的独特风险和服务需求。乌克兰是东欧艾滋病毒流行最严重的国家之一，与俄罗斯一起占东欧和中亚新报告的艾滋病毒诊断的近90%。在乌克兰，妇女占所有艾滋病毒病例的40%，但全面解决妇女独特的艾滋病毒相关需求的艾滋病毒预防和吸毒治疗方案很少。 在这个为期两年的项目中，我们将对乌克兰两个城市的60名女性吸毒者和60名治疗和服务提供者进行深入的定性访谈。与吸毒妇女的访谈将探讨支持的来源，包括利用社会安全网计划;以及从政府和非政府实体寻求帮助和药物滥用治疗的经验。与服务提供者的访谈将询问他们与吸毒妇女打交道的经验，评估他们对性别问题的反应程度，并探讨他们对妇女易感染艾滋病毒的具体性别因素的反应程度。我们将创建一个资源地图，以确定现有的服务和服务差距，以及给定区域的服务提供者如何相互关联（例如，合作伙伴关系、转介系统或对抗关系）。这些信息将 该战略将用于制定一项针对吸毒妇女的综合服务战略，该战略将反映乌克兰的卫生和社会服务背景。在未来，R 01研究，这套为妇女量身定制的服务和计划将与现有的标准服务包进行比较。

 DESCRIPTION (provided by applicant): Despite widespread recognition of the gendered nature of HIV risk, globally, women are underrepresented in HIV and drug treatment programs. Women are less likely than men to access needle/syringe exchange programs and have less access to and use of opioid substitution therapy. Women who use drugs encounter gender-related barriers to receiving appropriate and necessary HIV and drug use treatment and care, including stigma and lack of appropriate services. Moreover, women who use drugs have HIV-related risks that differ from men's risks. Women encounter HIV risks related to drug use, sex, and a constellation of personal, economic, and social factors. Female drug users also often experience high levels of poverty, financial dependence, and violence and abuse, which limit their ability to negotiate relationships and safer sex practices. The World Health Organization and UNAIDS, among others, have recognized the need for gender-specific prevention, treatment, and care programs and services; and a broad range of services for drug users that are accessible and convenient. In order to build comprehensive HIV prevention strategies that address the multiple contributors to women's HIV vulnerability, it is first necessary to understand existing systems of care, gaps in services, and the ways in which those at risk for HIV access and interact with service systems. This study will conduct a comprehensive assessment of HIV and drug use-related services for women in Ukraine to guide the development of a gender-informed, integrated service strategy that addresses the unique HIV-related risks and service needs of women who use drugs. Ukraine has one of the most severe HIV epidemics in Eastern Europe, and together with Russia accounts for almost 90 percent of Eastern Europe and Central Asia's newly reported HIV diagnoses. Women in Ukraine represent up to 40% of all HIV cases, but HIV prevention and drug use treatment programs that holistically address women's unique HIV-related needs are rare. In this 2-year project, we will conduct in-depth, qualitative interviews with 60 female drug users and 60 treatment and service providers in 2 Ukrainian cities. Interviews with women who use drugs will explore sources of support, including utilization of social safety net programs; and experiences seeking help and substance abuse treatment from governmental and nongovernmental entities. Interviews with service providers will ask about their experiences working with women who use drugs, assess their degree of gender- responsiveness, and explore how responsive they are to gender-specific contributors to women's HIV vulnerability. We will create a resource map to identify existing services and service gaps, and how service providers in a given area relate to one another (e.g., collaborative partnerships, referral systems, or antagonistic relationships). This information will be used to develop an integrated service strategy for women who use drugs that reflects the health and social service context in Ukraine. In a future, R01 study, this woman-tailored set of services and programs will be compared to existing standard packages of services.