Migrant Puerto Rican PWID: The Influence of Acculturation and Enculturation on HIV and HCV Risk Behaviors

移民波多黎各注射吸毒者：文化适应和适应对艾滋病毒和丙肝病毒危险行为的影响

• 批准号: 9271655
• 负责人: Camila Gelpi-Acosta
• 金额: $ 15.99万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-15 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9271655
• 关键词: AIDS/HIV problem; Acculturation; Achievement; Adopted; Adoption; Behavior; Biological Preservation; Brothers; Categories; Chicago; Client; Conflict (Psychology); Coupled; Data; Development; Economics; Elements; Enrollment; Environment; Epidemic; Ethnography; Event; Focus Groups; Geography; Goals; HIV; HIV Infections; HIV Seropositivity; HIV antiretroviral; HIV/HCV; Health; Health Services Accessibility; Hepatitis C Prevalence; Hispanics; Incidence; Infection; Injectable; Injecting drug user; Injection of therapeutic agent; Intervention; Interview; Language; Link; Location; Maintenance; Massachusetts; Needle Sharing; New Jersey; New York City; Nomads; Outcome; Perception; Pharmaceutical Preparations; Pharmacotherapy; Philadelphia; Policies; Population; Prevalence; Prevention; Prevention program; Process; Protocols documentation; Provider; Puerto Rican; Puerto Rico; Reporting; Research Infrastructure; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Role; Sampling; Services; Shares syringes; Sterility; Structure; Syringes; Technology; Testing; Time; United States; antiretroviral therapy; base; effective intervention; experience; health disparity; high risk; high risk behavior; improved; injection drug use; migration; prevention service; programs; public health relevance; socioeconomics; success; therapy development; transmission process; urban area

Project Summary/Abstract HIV incidence among people who inject drugs (PWID) in New York City (NYC) has reached its lowest rate in the past two decades. This achievement is linked to increased access to sterile syringes, drug treatment, and HIV antiretroviral therapy. Despite significant reductions in HIV prevalence among NYC PWID (from 50% in the 1980s to 12% today), injection-related transmission persists. Migrant PWID in NYC who began injecting in Puerto Rico (P.R.) are a key component of the PWID population that contributes to ongoing HIV incidence in the U.S. Migrant Puerto Rican PWID in NYC have pronounced language barriers, very high HCV prevalence, and significantly higher injection risk behaviors when compared to U.S.-born PWID (including U.S.-born Puerto Ricans). As a result, HIV and HCV prevalence is high in this population. In NYC in 2012, Hispanics were 45% of new HIV cases among PWID, and 39% of these new HIV cases among Hispanics occurred among migrant Puerto Ricans. Studies also suggest HIV infection in NYC is a likely outcome for many migrants. Currently, P.R.'s economic crisis is fueling the migration of thousands of Puerto Ricans to the U.S. mainland. Many of these are PWID searching for access to services that are scarce in P.R.: Drug and HIV/HCV treatment. Still, too many continue to engage in injection risks regardless of access to these services. While the presence of “native” norms influencing their injection risks are documented (e.g., a “Puerto Rican-way” to inject drugs endorsing syringe sharing among “brothers”), the extent of these risk norms, and their persistence over time, remain elusive. Because we do not understand these phenomena, we remain unprepared to help this population avoid acquiring and/or transmitting HIV/HCV after migration. We hypothesize there are two norm- related mechanisms influencing injection risks: (1) risk-acculturation – a process where through migrants' engagement in prevention programs they adopt NYC-specific [less risky] injection norms while replacing native [riskier] ones; and (2) risk-enculturation – whereby migrants may retain elements of their native injection norms despite access to services. Our goal is to help reduce health disparities by developing a risk-acculturation intervention to curb HIV/HCV infections in this population. To do this, we will conduct an exploratory study with 65 migrant Puerto Rican PWID, and 6 of their service providers, that will: 1) identify the native risk norms -and other influences- that require risk-acculturation, 2) explore existing risk reduction programs and services to identify limitations, and 3) develop and pilot test components of a risk-acculturation intervention for migrants. We will use a multilayered qualitative approach: 1) in-depth longitudinal interviews with 40 migrants, 2) two institutional ethnographies (one-time in-depth interviews with 10 migrants, and 6 service providers; coupled with structured observations), and 3) three focus groups (N=15 migrants). Intervention Mapping protocols will guide the intervention development process. Results will serve as a blueprint in the development of a comprehensive risk-acculturation intervention for migrant Puerto Rican PWID in a subsequent R34 proposal.

项目总结/摘要 纽约市注射毒品者（PWID）中的艾滋病毒发病率已达到2009年的最低水平。 过去的二十年这一成就与获得无菌注射器、药物治疗和 艾滋病毒抗逆转录病毒治疗。尽管纽约市艾滋病毒感染者中的艾滋病毒流行率显著下降（纽约市艾滋病毒感染者中的艾滋病毒流行率为50%， 20世纪80年代至今天的12%），与注射有关的传播仍然存在。纽约市的移民PWID开始注射 波多黎各是艾滋病毒感染者中的一个关键组成部分， 纽约市的美国移民波多黎各PWID有明显的语言障碍，非常高的HCV流行率， 与美国相比，出生的PWID（包括美国-出生于波多黎各 波多黎各人）。因此，艾滋病毒和丙型肝炎病毒的流行率在这一人群中很高。2012年，在纽约市，西班牙裔占45%， 艾滋病病毒感染者中的新艾滋病病毒病例占艾滋病病毒感染者中的39%，其中39%发生在移民中。 波多黎各人。研究还表明，纽约市的艾滋病毒感染是许多移民的可能结果。目前， P.R.波多黎各的经济危机促使成千上万的波多黎各人移民到美国大陆。许多 这些是PWID搜索公共关系中稀缺的服务：药物和HIV/HCV治疗。不过， 太多的人不顾这些服务，继续从事注射风险。而存在的 记录影响其注射风险的“本地”规范（例如，一种“波多黎各式”的注射毒品方式 赞同“兄弟”之间共用注射器），这些风险规范的程度，以及它们随时间的持续性， 仍然难以捉摸。因为我们不了解这些现象，我们仍然没有准备好帮助这个 人口在移徙后避免感染和/或传播艾滋病毒/HCV。我们假设有两个标准- 影响注射风险的相关机制：（1）风险-文化适应-一个过程，通过移民的 参与预防计划，他们采用纽约市特有的[风险较低的]注射规范，同时取代当地的 [风险]的;和（2）风险文化化-移民可能保留其本国注射规范的要素 尽管获得服务。我们的目标是通过发展一种风险文化适应， 采取干预措施，遏制这一人群中的艾滋病毒/丙型肝炎病毒感染。为此，我们将进行一项探索性研究， 65名移民波多黎各PWID，以及他们的6个服务提供商，将：1）确定本地风险规范-以及 其他影响-需要风险适应，2）探索现有的风险降低计划和服务， 查明局限性，以及3）为移民制定文化适应风险干预措施的组成部分并进行试点测试。 我们将使用多层次的定性方法：1）对40名移民进行深入的纵向访谈，2）两个 机构人种志（对10名移民和6名服务提供者进行一次性深入访谈; 结构化观察），和3）三个焦点小组（N=15移民）。干预标测方案将 指导干预发展进程。 结果将作为蓝图， 的发展 在随后的R34提案中，对波多黎各残疾人移民进行全面的风险适应干预。