Gender differences in perceived costs of safer injection among injection drug use

描述（由申请人提供）：高风险药物注射行为（例如，共用注射器、炊具、棉花和/或水进行注射，或共用注射器拆分药物）是注射吸毒者中人类免疫缺陷病毒（艾滋病毒）的一个重要传播途径。虽然近年来已经观察到注射吸毒者中的艾滋病毒危险行为有所减少，但残余注射危险行为仍然存在。例如，从2000年到2003年，38%的加州注射器交换计划（SEP）参与者报告了注射器共享，高达62%的人报告了用具共享。注射吸毒者中艾滋病毒风险存在着显著的性别差异。在妇女中，与注射有关的风险往往与她们使用毒品的社会和环境背景有关，而这种影响在男子中似乎不那么重要。一些个人层面的认知行为理论已被用来解释危险注射的做法，采用的结构，如感知的易感性，感知的严重性，自我效能，反应效能，社会规范和艾滋病毒知识。到目前为止，基于理论的研究已经成功地解释了注射风险行为使用这些结构。很少有研究探讨了安全注射的感知成本或障碍与注射风险之间的关联，更少的研究探讨了这些理论模型解释力的性别差异。这些遗漏可能部分解释了现有研究报告的不一致结果。为了更全面地了解注射风险行为的持续性，拟议的研究将测试一个理论模型，该模型以更安全注射的感知成本的形式整合了个人层面的认知和环境层面的因素。该模型结合了几个认知理论模型的结构，重点是感知成本和性别的调节作用。拟议的研究将从20个半结构化的定性访谈和200个横断面的定量访谈中收集数据，这些访谈是对从加州洛杉矶SEP招募的注射吸毒者进行的。样本将是种族多样的，33%为女性。本研究有四个具体目的：1）通过定性访谈确定与安全注射行为相关的感知成本，并开发一种用于定量调查的感知成本测量方法; 2）评估艾滋病相关认知因素与注射风险行为之间的关系; 3）运用结构方程模型（SEM）探讨了知觉成本对其他认知变量与注射风险行为之间关系的调节作用;（4）运用结构方程模型探讨认知成本和认知行为变量之间的关联强度的性别差异。拟议研究的结果可用于设计干预措施，以减轻注射吸毒者中安全注射的社会和环境成本，特别是帮助减轻女性注射吸毒者中安全注射的障碍。如果安全行为的成本可以最小化，注射吸毒者可能更有可能根据现有的艾滋病毒认知采取行动，以减少他们与注射有关的风险行为。通过查明导致注射吸毒者中与注射有关的艾滋病毒风险持续存在的因素，可以制定旨在解决这些因素的干预措施。具体来说，这项研究将确定更安全的注射行为的感知成本，从而制定旨在减轻更安全行为成本的艾滋病毒预防干预措施。此外，详细了解这些因素如何因性别而异，将有助于设计和实施有针对性的干预措施，这些措施将考虑到男女的社会和环境背景，以及那些导致妇女感染艾滋病毒风险增加的因素。

DESCRIPTION (provided by applicant): High-risk drug injection behavior (e.g., injecting with shared syringes, cookers, cotton, and/or water, or splitting drugs with shared syringes) is a significant route of transmission for human immunodeficiency virus (HIV) among IDUs. Though reductions in HIV risk behavior among IDUs have been observed in recent years, residual injection risk behavior persists. For example, from 2000 to 2003, 38% of California syringe exchange program (SEP) participants reported syringe sharing and up to 62% reported paraphernalia sharing. Significant gender differences exist in HIV risk among IDUs. Among women, injection-related risk is often associated with the social and environmental context in which they use drugs, whereas this influence appears to be less significant among men. Several individual-level, cognitive behavioral theories have been used to explain risky injection practices, employing constructs such as perceived susceptibility, perceived severity, self-efficacy, response efficacy, social norms, and HIV knowledge. To date, theoretically-based studies have had mixed success in explaining injection risk behavior using these constructs. Few studies have examined the association between perceived costs or barriers to safer injection and injection risk, and even fewer have examined gender differences in the explanatory power of these theoretical models. These omissions may partially explain the inconsistent results reported by existing studies. In order to more fully understand the persistence of injection risk behavior, the proposed study will test a theoretical model that integrates both individual-level cognitive and environmental- level factors in the form of perceived costs of safer injection. The model incorporates constructs from several cognitive theoretical models, with a focus on the moderating influence of perceived costs and gender. The proposed study will collect data from 20 semi-structured, qualitative interviews and 200 cross- sectional, quantitative interviews with IDUs recruited from a Los Angeles, California SEP. The sample will be ethnically diverse and 33% female. The study has four specific aims: 1) Identify the perceived costs associated with safer injection behavior via qualitative interviews and develop a measure of perceived costs that will be used in a quantitative survey; 2) Assess the relationship between HIV-related cognitive factors and injection risk behavior; 3) Use Structural Equation Modeling (SEM) to explore the moderating influence of perceived costs on the association between other cognitive variables and injection risk behavior; and 4) Use SEM to explore gender differences in perceived costs and in the strength of associations between cognitive and behavioral variables. Findings from the proposed study could be used to design interventions to mitigate the social and environmental costs of safer injection among IDUs, and specifically to help alleviate barriers to safer injection among female IDUs. If the costs of safer behavior can be minimized, IDUs may be more likely to act upon existing HIV cognitions to reduce their injection-related risk behavior. By identifying those factors that contribute to persistent injection-related risk for HIV among injection drug users, interventions designed to address those factors can be developed. Specifically, this study will identify the perceived costs of safer injection behavior, allowing for the development of HIV prevention interventions designed to mitigate the costs of safer behavior. Additionally, a detailed understanding of how these factors differ by gender will help in the design and implementation of tailored interventions that take into account the social and environmental context of both men and women, and those factors that contribute to elevated risk for HIV among women.