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

描述（由申请人提供）：感染人类免疫缺陷病毒（HIV）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，妇女目前占新诊断的四分之一以上，主要感染方式是异性性接触（疾病预防控制中心，2006年）。甲基苯丙胺（MA）是一种被滥用的药物，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; Rawson, washington, Domier, & Reiber, 2002; Semple, Grant, & Patterson, 2004），与其他非法药物不同，女性使用MA的比例似乎与男性相同（Cardona, 2007）。目前的数据表明，在美国，女性占与兴奋剂有关的急诊科就诊的40%，占MA治疗入院的45% （SAMHSA， 2004年）。研究人员越来越认识到语境因素的重要性，包括权力，作为理解女性艾滋病风险行为的必要因素（Amaro, 1995; Bourgois, 1995; Bourgois, Prince, & Moss, 2004; Epele, 2002; Farmer, Connors, & Simmons, 1996; Gomez & Marin, 1996； Kershaw等人，2006;Wingood & DiClemente, 2000; Wingood & DiClemente, 2002）。然而，很少有实证研究调查权力及其与吸毒妇女艾滋病毒风险行为的关系。本研究建议利用结构、社会心理和行为理论来指导非注射女性MA使用者对权力的理解。该项目的目的是更好地了解权力如何影响女性MA使用者滥用药物和与艾滋病毒相关的性风险行为。通过使用混合方法，该资助将解决以下目标：1)理解和描述对使用女性的男性管理人员来说突出的多层次权力问题；2)修改评估这一群体人际权力的SRPS，并将三个额外的权力层面（结构、文化和个人）付诸实施；3)初步评估修正力量量表的心理测量特性；4)探讨该人群权力问题的发生率及其与吸毒和hiv相关性危险行为的关系；5)确定针对这一人群的显著权力水平的干预策略。迄今为止，关于权力的方法和实证研究是有限的，并且没有关于使用女性的MA的权力的实证研究。为了获得更多关于多层次权力、药物使用和艾滋病毒性行为风险行为之间关系的经验信息，有必要初步开发一种创新措施来评估使用MA的妇女之间的权力动态。未来的研究将包括在其他亚人群中验证这一规模，并利用该研究的信息开发一种艾滋病预防干预措施，用于治疗期未治愈的女性，这种干预措施建立在多层次权力理论的基础上，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.