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

 描述（由申请人提供）：注射毒品（PWID）和艾滋病毒感染者经常经历双重耻辱。污名是指社会中对不受欢迎的个体的排斥和非人性化，可能会对PWID中的风险行为和医疗保健利用产生不利影响。与脚本（污名应对，以减少艾滋病毒的风险和改善物质使用预防和治疗）研究，我寻求扩大我在成瘾医学和公共卫生的专业知识，以适应和评估干预措施，解决双重污名艾滋病毒感染者通过这些培训目标：1）应用行为理论，以了解和解决艾滋病毒感染者中的污名; 2）分析污名及其与艾滋病风险和卫生保健利用的关系; 3）获得适应减少污名干预措施的能力; 4）获得规划和实施这种干预措施的试点研究的专业知识。他人的污名化态度导致自我污名化，这可能对危险行为、成瘾治疗和艾滋病毒护理寻求产生不利影响。然而，在艾滋病毒感染者中进行的研究中，自我污名受到的关注有限。该研究建议利用现有的数据，从美国国立卫生研究院支持的研究与艾滋病毒感染的PWID在俄罗斯检查影响因素的双重耻辱和它的作用，在这一关键人群的物质使用和医疗保健利用。我还建议开始通过调整和试点测试污名干预来解决这个问题。在辅导K99阶段，我将进行二次分析现有的定量数据，从艾滋病毒感染的PWID在俄罗斯（n=360），并检查物质使用和社会因素，影响艾滋病毒的自我耻辱，物质使用的自我耻辱，和耻辱的作用，卫生保健利用和艾滋病毒传播的风险。为了提高我们对如何解决这些问题的理解，我将进行一项定性研究，以进一步探讨污名化的潜在可改变方面。这将为调整针对感染艾滋病毒的残疾人的干预措施提供信息，以解决耻辱问题。培训和指导的研究相关的TSTT研究将是必不可少的，我过渡到独立的污名研究者。对于R 00阶段，我建议调整和试点测试针对PWID的耻辱干预，使他们能够科普与耻辱相关的羞耻和回避。这项试点研究将为R 01应用于PWID污名干预的大型随机对照试验奠定基础。

 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.