Identifying Intersectional Stigma Intervention Targets for People Who Inject Drugs in a High-Risk International Setting

220.7项目摘要/摘要 耻辱是在注射吸毒者(PWID)中预防艾滋病毒的普遍障碍。吉尔吉斯斯坦是中国的一部分 在东欧和中亚地区，艾滋病毒是世界上传播最快的艾滋病毒疫情 主要集中在PWID中。提高PWID在针头和注射器计划(NSP)中的参与度， 治疗阿片使用障碍(MMT)的美沙酮和治疗艾滋病毒(HIV+PWID)的抗逆转录病毒药物(ART)是 这对于结束该地区的艾滋病毒流行至关重要。大量定性研究文件表明，PWID 与与艾滋病毒、药物使用和药物治疗(即美沙酮)有关的耻辱作斗争，这些污名会破坏 参与这些关键的艾滋病毒预防服务。然而，人们对这些相互交错的污点中的哪一个知之甚少。 是最关键的干预措施，以改善艾滋病毒预防服务的参与度。进一步说，重点是 尽管农村地区艾滋病毒发病率增加，但跨部门耻辱并未延伸到该地区的农村地区 区域。结构方程建模--一种稳健的量化方法--可以确定这些污名中哪些是最 必须采取干预措施，以优化城乡残疾人参与艾滋病毒预防服务的工作。 目前的研究将采用受访者驱动抽样的方式招募城市(n=102)和农村(n=102)成年PWID。 艾滋病毒、药物使用和美沙酮污名的经历，以及参与NSP、MMT(初级)的水平 (结果)和ART(次要结果)服务将在基线上进行衡量。结构方程建模 将用于确定减少污名和提高对艾滋病毒预防服务的参与度的最佳点S(AIM 1)。将在基线后3个月进行后续评估，以获得研究保留评估和 在未来的疗效试验中完善保留城市和农村PWID的方案(目标2)。由四个数据驱动的系列 将与PWID(n=20)和主要利益攸关方(n=20)举办社区知情讲习班，以制定 为吉尔吉斯斯坦城乡地区量身定做的减少耻辱干预措施(目标3)。吉尔吉斯联合调查员 将大量参与这一项目的各个层面，以建立国内在耻辱和艾滋病毒科学方面的能力。 这将使我们的吉尔吉斯斯坦团队能够在艾滋病毒感染的地区培养下一代研究学者 疫情正在迅速扩大，与艾滋病相关的死亡率也在攀升。这个项目将为 为在吉尔吉斯斯坦的城乡残疾人中实施未来的减少耻辱干预措施奠定基础。 作为第一项量化交叉污名(艾滋病毒、药物使用、美沙酮)对艾滋病毒预防影响的研究 在城市和农村的PWID中，这项研究具有重要意义，因为耻辱是迅速 在欧洲和非洲经济共同体扩大艾滋病毒流行--由于对艾滋病毒预防服务(包括艾滋病毒治疗)参与度低。 这项研究具有很高的创新性，因为它反映了艾滋病毒、药物使用、 而美沙酮污名在PWID中已经被研究，打开了新的机会扭转了快速扩张的趋势 艾滋病毒在该地区的流行。

220.7 PROJECT SUMMARY/ABSTRACT Stigma is a pervasive barrier to preventing HIV among persons who inject drugs (PWID). Kyrgyzstan is part of the world’s most rapidly expanding HIV epidemic in the Eastern Europe and Central Asia region, where HIV is predominantly concentrated among PWID. Improving PWID engagement in needle and syringe programs (NSP), methadone to treat opioid use disorder (MMT), and antiretrovirals (ART) to treat HIV (among HIV+ PWID) is essential to ending the HIV epidemic in this region. Substantial qualitative research documents that PWID contend with stigmas related to HIV, drug use, and drug treatment (i.e. methadone), which undermine engagement in these key HIV prevention services. Yet, less is known about which of these intersecting stigmas are most critical to intervene on to improve engagement in HIV prevention services. Further, the focus of intersectional stigma has not been extended to rural PWID in the region despite increased HIV incidence in rural areas. Structural equation modeling–a robust quantitative method–can identify which of these stigmas are most critical to intervene on to optimize engagement in HIV prevention services among urban and rural PWID. The current study will recruit urban (n = 102) and rural (n = 102) adult PWID using respondent driven sampling. Experiences with HIV, drug use, and methadone stigma, and level of engagement in NSP, MMT (primary outcome) and ART (secondary outcome) services will be measured at baseline. Structural equation modeling will be used to identify optimal points to reduce stigma and improve engagement in HIV prevention service s (Aim 1). A follow up assessment will be conducted 3 months post-baseline to obtain study retention estimates and refine protocols for retaining urban and rural PWID in a future efficacy trial (Aim 2). A series of four data-driven and community-informed workshops with PWID (n = 20) and key stakeholders (n =2 0) will be held to develop stigma reduction interventions tailored to urban and rural regions in Kyrgyzstan (Aim 3). Kyrgyz co-investigators will be substantially involved at every level of this project to build in-country capacities in stigma and HIV science. This will enable our Kyrgyz team to develop the next generation of research scholars in a region where the HIV epidemic is rapidly expanding, and the incidence of AIDS-related mortality is climbing. This project will lay the groundwork to implement a future stigma reduction intervention among urban and rural PWID in Kyrgyzstan. As the first study to quantify the impact of intersecting stigmas (HIV, drug use, methadone) on HIV prevention among urban and rural PWID, this study is significant because stigma is a key sociostructural driver of a rapidly expanding HIV epidemic in EECA–due to low engagement in HIV prevention services (including HIV treatment). This study is highly innovative because it reflects a substantial departure from how intersecting HIV, drug use, and methadone stigma has been studied among PWID, opening new opportunities reverse a rapidly expanding HIV epidemic in the region.