Understanding the Role of Power in Drug Use and HIV Risk Behaviors Among Non-Inje

描述（由申请人提供）：人类免疫缺陷病毒（HIV）感染是妇女日益关注的公共卫生问题。在艾滋病毒流行之初，受感染的妇女相对较少。然而，妇女目前占新诊断病例的四分之一以上，主要的感染方式是异性接触（疾病预防控制中心，2006年）。甲基苯丙胺（MA）是一种滥用药物，已被证明会增加女性的性风险行为（Klee，1993; Lorvick，Martinez，& Laurne，2006; Molitor，Truaz，Ruiz，& Sun，1998;罗森，Washton，Domier，& Reiber，2002; Semple、Grant和Patterson，2004年），而且与其他非法药物不同，妇女使用MA的比例似乎与男子相同（Cardona，2007年）。目前的数据表明，在美国，女性占兴奋剂相关急诊就诊人数的40%，占MA治疗入院人数的45%（SAMHSA，2004）。研究人员越来越认识到包括权力在内的背景因素的重要性，这对于理解女性的艾滋病毒风险行为至关重要（Amaro，1995; Bourgois，1995; Bourgois，Prince，& Moss，2004; Epele，2002; Farmer，Connors，& Simmons，1996; Gomez & Marin，1996; Kershaw et al.，2006; Wingood & Di Clemente，2000; Wingood & DiClemente，2002）。然而，很少有实证研究探讨权力及其与吸毒妇女艾滋病风险行为的关系。本研究拟以非注射毒品女性使用者为样本，运用结构、社会心理和行为理论，探讨其对权力的理解。该项目的目的是更好地了解权力如何影响女性MA用户在药物滥用和艾滋病毒相关的性风险行为。通过使用混合方法，该赠款将解决以下目标：1）理解和描述多层次的权力问题，这是显着的MA使用妇女; 2）修改SRPS，评估人际权力，为这一人口和操作三个额外的权力水平（3）对修订后的权力量表进行初步的心理测量学评价; 4）探讨权力问题在这一人群中的流行程度及其与药物使用和艾滋病毒相关性风险行为的关系; 5）确定针对这一人群的突出权力水平的干预策略。到目前为止，关于权力的方法和实证研究是有限的，也没有实证研究的权力与MA使用妇女。初步开发的一种创新的措施，以评估MA使用妇女之间的权力动态是必要的，以获得更多的经验信息之间的关系，多层次的权力，药物使用和艾滋病毒的性风险行为。未来的研究将包括在其他亚群中验证这一量表，并利用研究中的信息，为使用女性的治疗外MA制定艾滋病毒预防干预措施，该干预措施建立在多层次的力量理论基础上，可以在更大的临床对照试验中进行测试。 公共卫生相关性：随着妇女艾滋病毒感染的增加和使用甲基苯丙胺（MA）的妇女中高风险性行为的流行，研究人员必须努力更好地了解影响这一人群中风险行为的背景问题。通过使用混合方法，本研究建议操作和开发一个量表，以评估这一人群的权力问题的四个层面：结构，文化，人际和个人，并确定相关的干预策略，以影响显着的权力水平。未来的研究将包括在其他亚群中验证这一量表，并利用该研究的信息开发一种基于多水平功效理论的艾滋病预防干预措施，这种干预措施可以在更大的临床对照试验中进行测试。

DESCRIPTION (provided by applicant): Infection with the Human Immunodeficiency Virus (HIV) is an increasing public health concern among women. At the beginning of the HIV epidemic relatively few women were infected. However, women currently comprise over a quarter of new diagnoses and the primary mode of infection is heterosexual contact (CDC, 2006). Methamphetamine (MA) is a drug of abuse that has been shown to increase sexual risk behaviors among women (Klee, 1993; Lorvick, Martinez, & Laurne, 2006; Molitor, Truaz, Ruiz, & Sun, 1998; Rawson, Washton, Domier, & Reiber, 2002; Semple, Grant, & Patterson, 2004) and unlike other illicit drugs women appear to be using MA in equal portions to men (Cardona, 2007). Current data indicate that women account for 40% of stimulant related emergency department visits and 45% of MA treatment admissions in the United States (SAMHSA, 2004). Researchers are increasingly recognizing the importance of contextual factors, including power, as essential to understanding HIV risk behaviors among women (Amaro, 1995; Bourgois, 1995; Bourgois, Prince, & Moss, 2004; Epele, 2002; Farmer, Connors, & Simmons, 1996; Gomez & Marin, 1996; Kershaw et al., 2006; Wingood & Di Clemente, 2000; Wingood & DiClemente, 2002). However, few empirical studies have investigated power and its relationship to HIV risk behaviors among drug using women. This study proposes to draw upon structural, psychosocial and behavioral theories to guide the understanding of power among a sample of non-injecting female MA users. The aim of this project is to better understand how power impacts female MA users in relation to drug abuse and HIV-related sex risk behaviors. Through using mixed methods this grant will address the following aims: 1) to understand and describe the multi-level power issues that are salient for MA using women; 2) to modify the SRPS that assesses interpersonal power for this population and to operationalize three additional levels of power (structural, cultural and individual); 3) to assess preliminary psychometric properties of the modified power scale; 4) to explore the prevalence of power issues in this population and their relationship to drug use and HIV-related sex risk behaviors; and 5) to identify intervention strategies that will target the salient levels of power for this population. To date, methodological and empirical research on power is limited and there are no empirical studies of power with MA using women. The preliminary development of an innovative measure to assess power dynamics among MA using women is necessary in order to obtain further empirical information on the relationship between multiple levels of power, drug use and HIV sex risk behaviors. Future research would include validating this scale among other subpopulations and using information from the study to develop an HIV prevention intervention for out-of treatment MA using women that is founded on a multi-level theory of power that could be tested in a larger clinical control trial. PUBLIC HEALTH RELEVANCE: With the increase of HIV infection among women and the prevalence of high risk sex behaviors among methamphetamine (MA) using women, researchers must strive to better understand contextual issues that impact risk behaviors among this population. Through using mixed methods, this study proposes to operationalize and develop a scale to assess power issues for this population on four levels: structural, cultural, interpersonal and individual and to identify relevant intervention strategies to impact the salient levels of power. Future research would include validating this scale among other subpopulations and using information from the study to develop an HIV prevention intervention founded on multi-level theory of power that could be tested in a larger clinical control trial.