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

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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).