Stigma, Risk Behaviors and Health Care among HIV-infected Russian People Who Inject Drugs

 描述（由申请人提供）：注射吸毒者（注射吸毒者）并感染艾滋病毒的人经常遭受双重耻辱。耻辱，即对不良社会类别中的个人的排斥和非人化，可能会对吸毒者的危险行为和医疗保健利用产生不利影响。通过 SCRIPT（减少艾滋病毒风险和改善药物滥用预防和治疗的耻辱）研究，我寻求扩展我在成瘾医学和公共卫生方面的专业知识，通过以下培训目标调整和评估解决吸毒者感染艾滋病毒的双重耻辱的干预措施：1）应用行为理论来理解和解决感染艾滋病毒的吸毒者的耻辱； 2) 分析耻辱及其与艾滋病毒风险和医疗保健利用的关系； 3) 获得适应减少耻辱干预措施的能力； 4) 获得规划和实施该干预试点研究的专业知识。他人的污名化态度会导致自我污名化，这可能会对危险行为、成瘾治疗和艾滋病毒护理寻求产生不利影响。然而，在对感染艾滋病毒的吸毒者进行的研究中，自我耻辱受到的关注有限。 SCRIPT 研究建议利用 NIH 支持的俄罗斯艾滋病毒感染者研究的现有数据来研究影响双重耻辱的因素及其在这一关键人群的物质使用和医疗保健利用中的作用。我还建议通过调整和试点污名干预措施来开始解决这个问题。在 K99 指导阶段，我将对俄罗斯艾滋病毒感染者 (n=360) 的现有定量数据进行二次分析，并研究影响艾滋病毒自我耻辱的物质使用和社会因素、物质使用自我耻辱以及耻辱对医疗保健利用和艾滋病毒传播风险的作用。为了加深我们对如何解决这些问题的理解，我将进行一项定性研究，以进一步探索耻辱的潜在可改变方面。这将为针对感染艾滋病毒的吸毒者采取干预措施以消除耻辱提供信息。与 SCRIPT 研究相关的培训和指导研究对于我向独立耻辱研究员的过渡至关重要。对于 R00 阶段，我建议调整并试点针对吸毒者的耻辱干预措施，使他们能够应对与耻辱相关的羞耻和回避。这项试点研究将为 R01 申请奠定基础，以进行针对吸毒者耻辱干预的更大规模随机对照试验。

 DESCRIPTION (provided by applicant): People who inject drugs (PWID) and live with HIV infection often experience double stigmatization. Stigma, the exclusion and dehumanization of individuals in an undesirable social category, may have adverse effects on risk behaviors and health care utilization among PWID. With the SCRIPT (Stigma Coping to Reduce HIV risks and Improve substance use Prevention and Treatment) study, I seek to extend my expertise in addiction medicine and public health to adapt and evaluate interventions addressing the double stigma for PWID living with HIV through these training goals: 1) to apply behavioral theories to understand and address stigma among PWID living with HIV; 2) to analyze stigma and its relation to HIV risks and health care utilization; 3) to acquire competence in the adaptation of a stigma-reduction intervention; 4) to gain expertise in planning and implementing a pilot study of this intervention. Stigmatizing attitudes by others lead to self-stigma, which can have an adverse impact on risk behaviors, addiction treatment and HIV care seeking. Yet, self-stigma has received limited attention in studies conducted among HIV-infected PWID. The SCRIPT study proposes to make use of existing data from NIH-supported studies with HIV-infected PWID in Russia to examine factors affecting the double stigma and its role in substance use and health care utilization in this key population. I also propose to begin to address the problem by adapting and pilot-testing a stigma intervention. In the mentored K99 phase, I will conduct secondary analysis of existing quantitative data from HIV-infected PWID in Russia (n=360) and examine substance use and social factors that affect HIV self-stigma, substance use self-stigma, and stigma's role on health care utilization and risks for HIV transmission. To enhance our understanding of how to address these issues, I will conduct a qualitative study to further explore potentially modifiable aspects of stigma. This will inform the adaptation of an intervention for PWID living with HIV to address stigma. The training and the mentored research related to the SCRIPT study will be essential to my transition to independent stigma researcher. For the R00 phase, I propose to adapt and pilot- test a stigma intervention to target PWID to empower them to cope with shame and avoidance related to stigma. This pilot study will lay the base for an R01 application for a larger randomized control trial of a stigma intervention for PWID.