Identifying Stigma Reduction Targets in the Context of an Appalachian HIV Outbreak

在阿巴拉契亚艾滋病毒爆发的背景下确定减少耻辱的目标

• 批准号: 10670313
• 负责人: Robin A Pollini
• 金额: $ 22.3万
• 依托单位: WEST VIRGINIA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10670313
• 关键词: AIDS prevention; Acute Hepatitis; Address; Affect; Appalachian Region; Caring; Centers for Disease Control and Prevention (U.S.); Communities; Continuity of Patient Care; County; Data; Development; Disease Outbreaks; Drops; Drug usage; Early Diagnosis; Ensure; Equipment; Exclusion; Family; Foundations; General Population; Goals; HIV; HIV diagnosis; Health Personnel; Hepatitis B; Hepatitis C; Human immunodeficiency virus test; Incidence; Indiana; Individual; Infection; Injecting drug user; Injections; Intervention; Interview; Investigation; Knowledge; Location; Measures; Methods; Modeling; Needle Sharing; Needle-Exchange Programs; Overdose; Oxymorphone; Pharmaceutical Preparations; Phase; Population; Populations at Risk; Prevention; Prevention program; Provider; Research; Rural; Rural Appalachia; Rural Community; Rural Population; Sampling; Services; Site; Source; Surveys; Testing; Viral; West Virginia; disease transmission; drug testing; evidence base; experience; health assessment; health care service utilization; health service use; high risk; improved; injection drug use; innovation; insight; interest; internalized stigma; novel; opioid epidemic; outbreak response; phase 1 study; pre-exposure prophylaxis; prevent outbreaks; prevention service; programs; rural America; rural area; scale up; service utilization; social stigma; substance use; testing services; testing uptake; therapy design; tool; transmission process; uptake; urban area; vulnerable community

PROJECT SUMMARY/ABSTRACT This study will examine how drug-related stigma influences the utilization of HIV prevention and testing programs among people who inject drugs (PWID) in the context of ongoing HIV outbreaks in Appalachia. The opioid crisis has contributed to high levels of injection drug use in rural communities, leaving them highly vulnerable to HIV outbreaks. Scaling up evidence-based HIV prevention and testing programs is critical for averting these outbreaks but even where these programs exist, often they are not used by PWID. Drug-related stigma may pose a substantial barrier to engaging in these services, especially in rural communities where anonymity and confidentiality are difficult to maintain. However, there is limited research on how drug-related stigma and its individual constructs (e.g., enactedstigma, anticipated stigma, internalized stigma) affect program uptake among PWID. Our study will used a sequential mixed methods approach to fill these knowledge gaps by (1) exploring the ways in which stigma influences the utilization of HIV prevention and testing programs among rural PWID, (2) adapting and validating an existing stigma scale, the Substance Use Stigma Mechanisms Scale (SU-SMS), for rural PWID, and (3) characterizing the types and sources of stigma that serve as barriers to HIV prevention and testing program participation in this population. The study will be conducted at two sites in West Virginia, which is the location of ongoing HIV outbreaks fueled by injection drug use. In Phase I of the study, we will conduct qualitative interviews with PWID (N=40) and healthcare providers (N=24) to provide insight into how stigma is operationalized in the context of HIV services utilization. In Phase II, we will conduct a survey of PWID (N=300) to adapt and validate the SU-SMS. Then, we will model the association between individual stigma constructs and HIV prevention and testing program use while also considering other structural- and individual-level factors that influence healthcare utilization. The resulting information will assist us in targeting, developing, and testing novel stigma-reduction interventions designed to improve rural PWID engagement in HIV prevention and testing services, with the ultimate goal of reducing HIV transmission among PWID in rural communities.

项目概要/摘要 本研究将探讨与毒品相关的耻辱如何影响艾滋病毒预防和检测的利用 在阿巴拉契亚地区艾滋病毒持续爆发的背景下，针对注射吸毒者（PWID）的项目。这 阿片类药物危机导致农村社区注射毒品使用率很高，使他们高度依赖注射毒品。 容易受到艾滋病毒爆发的影响。扩大基于证据的艾滋病毒预防和检测计划对于 避免这些疾病的爆发，但即使存在这些计划，注射吸毒者通常也不会使用它们。毒品相关 耻辱可能会对参与这些服务构成重大障碍，特别是在农村社区，因为 匿名性和保密性很难维持。然而，关于药物如何相关的研究还很有限。 耻辱及其个体结构（例如，表现的耻辱、预期的耻辱、内在的耻辱）影响 吸毒者中对该计划的接受程度。我们的研究将使用顺序混合方法来填补这些 通过以下方式消除知识差距：(1) 探索耻辱感如何影响艾滋病毒预防和治疗的利用 农村注射吸毒者的测试计划，(2) 调整和验证现有的耻辱量表，即药物使用 耻辱机制量表 (SU-SMS)，适用于农村吸毒者，以及 (3) 描述耻辱的类型和来源 这些因素成为该人群参与艾滋病毒预防和检测计划的障碍。该研究将是 在西弗吉尼亚州的两个地点进行了这项研究，西弗吉尼亚州是注射毒品导致艾滋病毒持续爆发的地区 使用。在研究的第一阶段，我们将对注射吸毒者 (N=40) 和医疗保健提供者进行定性访谈 (N=24) 深入了解在艾滋病毒服务利用的背景下耻辱是如何运作的。同相 II，我们将对注射吸毒者（N=300）进行调查，以适应和验证 SU-SMS。然后，我们将建模 个人耻辱感与艾滋病毒预防和检测计划的使用之间的关联，同时也 考虑影响医疗保健利用的其他结构和个人层面的因素。由此产生的 信息将帮助我们瞄准、开发和测试旨在减少耻辱的新颖干预措施 提高农村吸毒者对艾滋病毒预防和检测服务的参与，最终目标是减少艾滋病毒 农村社区注射吸毒者之间的传播。