HIV risk, PrEP disparities, and stigma among Women who use Drugs(WWUD) in the U.S. South, with attention to race and sexual orientation: A mixed-methodintersectionality study

美国南部吸毒女性 (WWUD) 的 HIV 风险、PrEP 差异和耻辱，关注种族和性取向：一项混合方法交叉研究

• 批准号: 10762621
• 负责人: Jennifer L Glick
• 金额: $ 4.44万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2023-12-04
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10762621
• 关键词: AIDS prevention; Attention; Awareness; Behavioral; Bioethics; Black Populations; Black race; Cities; Clinic; Complement; Complex; Data; Data Sources; Development Plans; Discrimination; Disparity; Distal; Drug usage; Ethnography; Fostering; Funding; German population; Goals; Grant; HIV; HIV Infections; HIV disparities; HIV risk; Health; Health Disparities Research; Healthcare; Heterosexuals; Incidence; Institution; Institutional Practice; Intervention Studies; Interview; Mentors; Methodology; Methods; Needle Sharing; Outcome; Pattern; Personal Satisfaction; Play; Policies; Positioning Attribute; Prevalence; Prevention Research; Provider; Public Health; Qualitative Methods; Race; Research; Research Activity; Research Design; Research Methodology; Research Personnel; Research Proposals; Resources; Risk; Risk Behaviors; Risk Reduction; Sampling; Sex Behavior; Sex Orientation; Social Processes; Social support; Stress; Subgroup; Techniques; Time; Training; United States National Institutes of Health; Unsafe Sex; Violence; Vulnerable Populations; Woman; Writing; alcohol misuse; barrier to care; care seeking; career; career development; cis-female; cohort; contextual factors; coping; design; drug misuse; effective intervention; ethnographic method; experience; health care settings; health equity; housing instability; illicit drug use; injection drug use; innovation; insight; intersectionality; lens; maladaptive behavior; marginalization; non-heterosexual; pre-exposure prophylaxis; protective behavior; protective factors; racial disparity; racism; resilience; resilience factor; sex; sexual minority; sexual minority women; sexual risk behavior; skills; social stigma; structural determinants; substance use; surveillance data; theories; therapy development; uptake

PROJECT SUMMARY/ABSTRACT HIV infection among cisgender women who use drugs (WWUD) in the US South is a critical public health issue. WWUD with diverse marginalized identities (e.g., Black heterosexual, White sexual minority) experience intersectional stigma uniquely, which can result in HIV risk/protective behavior (e.g., condomless sex, social support) and impact access to HIV prevention healthcare resources (PrEP). WWUD are PrEP indicated, but their PrEP continuum outcomes (i.e. awareness, acceptability, uptake) remain low. WWUD have complex proximal (e.g., syringe sharing) and distal (e.g., intersectional stigma experiences in healthcare settings) HIV risk/resilience experiences that require further examination to develop effective interventions. Intersectionality theory, undergirding this proposal, acknowledges interlocking power dynamics (e.g., racism) playing out in social processes (e.g., intersectional stigma) to impact health outcomes and disparities. The proposed mixed- method research aims to study HIV risk/resilience, healthcare barriers/facilitators, and PrEP continuum disparities among WWUD in the US South, employing an intersectional strengths-based analytical lens to inform multi-level stigma-reduction, HIV prevention, and PrEP promotion initiatives. To do so, I will first describe HIV risk and PrEP continuum disparities by identifying WWUD subgroups based on intersectional identity (i.e., race X sexual orientation) and contextual factors (e.g., sex exchange) using intersectional quantitative approaches gained from training (e.g., latent class analyses) with southern National HIV Behavioral Surveillance data (Aim 1). Next, I will explore multi-level barriers/facilitators (e.g., intersectional stigma) in HIV prevention-related healthcare, HIV risk, and PrEP continuum via qualitative healthcare go-along interviews with a purposively selected sample of PrEP indicated WWUD in New Orleans, LA (Aim 2). Subsequently, I will explore institutional practices related to WWUD identified barriers/facilitators to HIV prevention-related healthcare seeking, HIV risk, and PrEP continuum utilizing institutional ethnography (Aim 3). This proposed research will facilitate application of training objectives towards my long-term career goal of becoming an independent NIH-funded HIV prevention and health equity investigator. My career development plan, including an expert team of mentors, (Drs. Latkin, Bowleg, Theall, German, Baral), centers the following training objectives: 1) develop comprehensive expertise in intersectionality theory application, associated mixed-methods study design approaches, and advanced ethnographic methodology (e.g., go-along interviews); 2) develop advanced statistical theory and methods to conduct quantitative intersectionality analyses(e.g., latent class analysis); 3) gain expertise in multi-level intersectional stigma theory and ethnographic methods(e.g., institutional ethnographies); and 4) develop skills needed for a successful academic career in intersectional mixed-method HIV prevention research with vulnerabilized populations (e.g., research bioethics, multi-stakeholder dissemination, grant writing; and interdisciplinary networking).

项目摘要/摘要 美国南部使用毒品(WWUD)的顺性女性感染艾滋病毒是一个关键的公共卫生问题 问题。具有不同边缘化身份的WWUD(例如，黑人异性恋者、白人性少数)经历 独特的跨部门污名，这可能导致艾滋病毒风险/保护性行为(例如，无公寓的性行为、社交 支持)和影响获得艾滋病毒预防保健资源(PrEP)。WWUD表示为PrEP，但是 他们的PrEP连续结果(即知晓率、可接受性、接受度)仍然很低。WWUD有复杂性 近端(例如，共用注射器)和远端(例如，在医疗保健环境中的交叉耻辱经历)艾滋病毒 风险/复原力经验需要进一步审查，以制定有效的干预措施。交叉性 支持这一提议的理论承认，连锁权力动态(例如，种族主义)在 影响健康结果和差异的社会进程(例如，跨部门的耻辱)。建议的混合- 方法研究旨在研究HIV风险/复原力、医疗障碍/促进者和PrEP连续体 美国南部WWUD之间的差异，采用基于跨部门优势的分析透镜来 为多层次的减少污名、艾滋病毒预防和PrEP促进倡议提供信息。为此，我将首先 描述HIV风险和PrEP连续体差异，方法是根据交叉点确定WWUD亚组 身份(即种族X性取向)和背景因素(例如性别交换)使用交叉性 从南方国家艾滋病毒培训(例如，潜在类别分析)中获得的量化方法 行为监测数据(目标1)。接下来，我将探讨多层次障碍/促进者(例如，跨部门 耻辱)在与艾滋病毒预防相关的医疗保健、艾滋病毒风险和PrEP连续性中，通过质量医疗保健进行 对故意选择的PrEP样本的采访表明，WWUD在洛杉矶新奥尔良(目标2)。 随后，我将探讨与WWUD确定的艾滋病毒障碍/促进者有关的体制做法 利用机构人种学的预防相关保健寻求、艾滋病毒风险和PrEP连续体(目标3)。 这项拟议的研究将有助于将培训目标应用于我的长期职业目标 成为美国国立卫生研究院资助的独立艾滋病毒预防和健康公平调查者。我的职业发展 计划，包括一个专家团队的导师，(博士拉特金，鲍列格，西尔，德语，巴拉尔)，中心如下 培训目标：1)培养交叉性理论应用的综合专业知识， 混合方法研究设计方法和先进的人种学方法(例如 访谈)；2)发展先进的统计理论和方法，进行量化交叉 分析(例如，潜在类别分析)；3)获得多层次交叉污名理论方面的专业知识 人种学方法(例如，机构人种学)；和4)发展成功的 从事针对易感人群的跨部门混合方法艾滋病毒预防研究的学术生涯(例如， 研究生物伦理学、多方利益攸关方传播、赠款撰写和跨学科联网)。