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

项目总结/摘要 这项研究将探讨与毒品有关的耻辱感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，在注射毒品者（PWID）中开展的项目。的 阿片类药物危机导致农村社区注射毒品的使用率很高， 易受艾滋病爆发的影响扩大以证据为基础的艾滋病毒预防和检测方案对于 但即使存在这些程序，PWID通常也不会使用它们。药物相关 污名化可能对参与这些服务构成重大障碍，特别是在农村社区， 匿名性和保密性难以维持。然而，关于如何与毒品有关的研究有限。 污名及其个体结构（例如，预期污名，内化污名）情感 项目在PWID中的应用。我们的研究将采用序贯混合方法的方法来填补这些 （1）探讨污名化如何影响艾滋病毒预防的利用， 在农村PWID中测试项目，（2）调整和验证现有的耻辱量表，物质使用 污名机制量表（SU-SMS），用于农村PWID;（3）表征污名的类型和来源 这是该人群参与艾滋病预防和检测计划的障碍。本研究将 在西弗吉尼亚州的两个地点进行，这是正在进行的艾滋病毒爆发的地方，由注射毒品推动 使用.在研究的第一阶段，我们将对PWID（N=40）和医疗保健提供者进行定性访谈 （N=24），以了解如何在艾滋病毒服务利用的背景下运作的耻辱。同相 第二，我们将进行PWID调查（N=300），以适应和验证SU-SMS。然后，我们将对 个人污名结构与艾滋病毒预防和检测项目使用之间的关联， 考虑到影响医疗保健利用的其他结构和个人因素。所得 信息将帮助我们瞄准，开发和测试新的减少耻辱的干预措施， 改善农村艾滋病感染者参与艾滋病毒预防和检测服务，最终目标是减少艾滋病毒感染 在农村社区的PWID中传播。

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.