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

 描述(申请人提供)：注射毒品(PWID)和艾滋病毒感染者经常遭受双重污名。耻辱是对不良社会类别中的个人的排斥和非人化，可能会对PWID的危险行为和卫生保健利用产生不利影响。通过SCRIPT(应对污名以降低艾滋病毒风险和改善药物使用预防和治疗)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，以通过这些培训目标调整和评估针对PWID艾滋病毒感染者双重污名的干预措施：1)应用行为理论来了解和解决艾滋病毒感染者中的污名问题；2)分析污名及其与艾滋病毒风险和医疗保健利用的关系；3)获得适应污名减少干预措施的能力；4)获得规划和实施这种干预措施的试点研究方面的专业知识。将他人的态度污名化会导致自我羞辱，这可能会对危险行为、成瘾治疗和寻求艾滋病毒护理产生不利影响。然而，在HIV感染的PWID患者中进行的研究中，自我污名受到的关注有限。SCRIPT研究建议利用NIH支持的俄罗斯HIV感染PWID研究的现有数据来检查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行污名干预来开始解决这个问题。在指导K99阶段，我将对俄罗斯感染艾滋病毒的PWID(n=360)的现有定量数据进行二次分析，并检查影响艾滋病毒自我污名的物质使用和社会因素，物质使用自我污名，以及污名对卫生保健利用和艾滋病毒传播风险的作用。为了加强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修改方面。这将使对患有艾滋病毒的PWID患者的干预措施得以适应，以解决耻辱问题。与剧本研究相关的培训和指导研究将是我向独立耻辱研究人员过渡的关键。对于R00阶段，我建议适应和试点针对PWID的耻辱干预，使他们能够应对与耻辱相关的羞耻和回避。这项先导性研究将为R01应用于更大规模的耻辱干预PWID的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.